This is a digital copy of a book that was preserved for generations on library shelves before it was carefully scanned by Google as part of a project
to make the world's books discoverable online.
It has survived long enough for the copyright to expire and the book to enter the public domain. A public domain book is one that was never subject
to copyright or whose legal copyright term has expired. Whether a book is in the public domain may vary country to country. Public domain books
are our gateways to the past, representing a wealth of history, culture and knowledge that's often difficult to discover.
Marks, notations and other marginalia present in the original volume will appear in this file - a reminder of this book's long journey from the
publisher to a library and finally to you.
Usage guidelines
Google is proud to partner with libraries to digitize public domain materials and make them widely accessible. Public domain books belong to the
public and we are merely their custodians. Nevertheless, this work is expensive, so in order to keep providing this resource, we have taken steps to
prevent abuse by commercial parties, including placing technical restrictions on automated querying.
We also ask that you:
+ Make non-commercial use of the files We designed Google Book Search for use by individuals, and we request that you use these files for
personal, non-commercial purposes.
+ Refrain from automated querying Do not send automated queries of any sort to Google's system: If you are conducting research on machine
translation, optical character recognition or other areas where access to a large amount of text is helpful, please contact us. We encourage the
use of public domain materials for these purposes and may be able to help.
+ Maintain attribution The Google "watermark" you see on each file is essential for informing people about this project and helping them find
additional materials through Google Book Search. Please do not remove it.
+ Keep it legal Whatever your use, remember that you are responsible for ensuring that what you are doing is legal. Do not assume that just
because we believe a book is in the public domain for users in the United States, that the work is also in the public domain for users in other
countries. Whether a book is still in copyright varies from country to country, and we can't offer guidance on whether any specific use of
any specific book is allowed. Please do not assume that a book's appearance in Google Book Search means it can be used in any manner
anywhere in the world. Copyright infringement liability can be quite severe.
About Google Book Search
Google's mission is to organize the world's information and to make it universally accessible and useful. Google Book Search helps readers
discover the world's books while helping authors and publishers reach new audiences. You can search through the full text of this book on the web
at|http : //books . google . com/
97
^V
HARVARD UNIVERSITY
LIBRARY
DENTAL SCHOOL
EtOMOR
^^jczi^ZXh^ U-U,^
Received
/~</^/
Digitized by V:iOOQIC
:'*. :** :-: t a : •**• -'- : : '*• •'-, :
Digitized by V:iOOQIC
••• ••• •
• • • • •
•• •• • •
T m • • • •• • •• •
•• • •
> • • •
• • ••
• • ! : • •
• • -•"
• • • • •• •
Digitized by V:iOOQIC
Bental Btgejeit
TABLE OF CONTENTS
AND
GENERAL INDEX FOR VOL XXll.
JANUARY-DECEMBER, 1916
^' * » »^
» , - •*,
*^N^
EDITED BY
GEORGE WCK)D CLAPP. D. D. S.
PUBUSHED BY
THE DENTISTS' SUPPLY COMPANY
CANDLER BUILDING
220 WEST 42nd STREET, NEW YC»K
Digitized by V:iOOQIC
HARVARD UMJVM8I7Y
SCHOOL OF D TAL M£OJCI#IE
i.ir^.-..:-'
\
A\
• • • •
• • • •• •
• • • !• •
• ••• -•-
:'••• .• ••• •
• •••••• • •••• •
Digitized by V:iOOQIC
TABLE OF CONTENTS, 1916
VOLUME xxn
ORIGINAL CONTRIBUTIONS
PAGE
A Detachable Cusp for Steele V Facings..* ! M. G. Philups, D.D.S. 763
Accuracy in Amalgam Restorations : .W. Go'ddard Sherman, D.D.S. 562
Adjusting Obturators J. E. Kurlander, D.D.S. and H. J. Jaulusz, D.D.S. 217
American Fair Play 779
An April Vacation \V. B. Lee, D.D.S. 368
An Auto Trip, August, 1915 J. M. Miller, D.D.S. 376
An Intermaxillaiy Splint George Morris Dorrance,D.D.S. 645
An Outing in the Ozarks B. L. Gamble, D.D.S. 385
Anatomical Articulation, A Trip Registering the Western Attitude Toward
Dayton Dunbar Campbell, D.D.S. 79
Are State Dental Laws Reasonable? Name of Author Known but Withheld 710
Banquet to Mr. Thomas Forsyth 781
Better Gold Inlay, A W. Goddard Sherman, D.D.S. 149
Bleaching Technic of Natural Tooth in the Mouth Louis Englander, D.D.S. 215
Cast Cusp Gold Crown A. Bruce Coffin, D.D.S. 293
Closed Mouth Impressions Samuel G. Slt»plee, 4, 74, 139, 290, 413, 498, 567, 700, 764
Closure of Jaw in Mastication Loomis P. Haskell, D.D.S. 502
Complete Description of My Most Successful Operation H. M. Demarest, D.D.S. 627
Conservative and Constructive Treatment of Riggs' Disease M. H. Cazier, M.D. 775
Correct and Incorrect Cuspid Relations Russell W. Tench, D.D.S. 561
Cow Bell Method of Casting Aluminum Bases W. Clyde McClelland, D.D.S. 416
Cuspid Relations, Correct and Incorrect Russell W. Tench, D.D.S. 561
Delightful Camping Trip Walter S. Cole, D.D.S. 370
Delightful Vacation and Some Conclusions C. W. Weaver, D.D.S. 362
Dental Hygienists Edward F. Brown, D.D.S. 284
Devitalization, Shall we Discontinue Walter S. Kyes, D.D.S. 207
Eighth Annual Hay Fever Pilgrimage T. M. Robertson, D.D.S. 402
Evolution of a Prosthodontist Sinclair Weeks, D.D.S. 6
Exodontia Under Nitrous Oxide and Oxygen Anesthesia, Bertram R. Perkins, D.D.S. 796
Expansion and Contraction in Plaster and Vulcanite Stewart J. Spence, D.D.S. 491, 557
Experiments to Determine the Toxicity of Therapeutic Agents in the Treatment of
Pyorrhea on Normal Cells Grown m Vitro W. F. Spies, D.D.S. 69
Fate of An " Innocent Bystander" Floy Tolbert Barnard 345
Fatigue, Its Cause, Nature, and Cure Watson W. Eldridge, M.D. 398
Finishing Process of Artificial Dentures T. G. Healy, D.D.S. 422
Food for Dentists Watson W. Eldridge, M.D., 155, 276, 621
Gold Crown, Cast Cusp A. Bruce Coffin, D.D.S. 293
Gold Crowns, for Posterior Teeth, Where Bite is Very Close, Technic for Making
Raymond S. Scovil, D.D.S. 143
Gold Inlay, A Better W. Goddard Sherman, D.D.S. 149
Good Time in Pocahontas County, W. Va E. W. Hill, D.D.S. 384
Great National Movement, A W. G. Ebersole, M.D., D.D.S. 9
Hunting with Airedale Terriers A. P. Deacon, D.D.S. 351
Impacted Third Molar Causes Facial Paralysis B. Barrymore Marco, D.D.S. 566
Important Information from the Dental Protective Association of the United States . 85
Impressions, Closed Mouth .... Samuel G. Supplee, 4, 74, 139, 290, 413, 498, 567, 700, 764
iii
Digitized by
Google
iv TABLE OF CONTENTS, 1916
PAGE
Jaws, Fractured, Treatment of William C. Mogh, D.D.S. i
Launch Trip, A L. A. Lupton, D.D.S. 386
Ludwig's Angina Jno. W. Seybold, D.D.S. 483
My Quest for Pike W. S. Walters, D.D.S. 354
Natural Cleansing of the Mouth by Natural Means Bernard Feldman, D.D.S. 485
N. Y. College of Dentistry, Semi-centennial Celebration 410
Orthodontia of the Deciduous Teeth E. A. Bckue, D.D.S., M.D. 631, 691, 757
Our Vacation in 1915 J. C. Higgason, D.D.S. 390
Our Wisconsin River Trip C. F. Stekl, D.D.S. 374
Out in the Fields C. R. Christopher, D.D.S. 393
Perfect Articulation in Posterior Bridgework by the Use of Trubyte Molar Blocks
R. D. Pray, D.D.S. 294
Problem of Mouth Washes Chas. M. MacKenzie, D.M.D. 625
Progressive Prosthetic Clinic H. J. Horner, D.D.S., W. J. Holroyd, D.D.S.,
C. J. McChesney, D.D.S. 640
Progressive Prosthetic Clinic. ...H. C. Werts, D.D.S., F. A. Gallagher, D.D.S. 705, 707
Pyorrhea, Treatment of, Experiments to Determine the Toxicity of Therapeutic Agents
in the W. F. Spies, D.D.S. 69
Rapid and Accurate Method of Soldering the Pin to a Richmond Cap
J. M. WooDLE, D.D.S. 565
Rationale of Riggs' Disease Marion Howard Cazier, M.D. 553
Repairing Carious Teeth Harvey Richmond, D.D.S. 642
Riggs' Disease, Rationale of Marion Howard Cazier, M.D. 553
Rugae Victor Lay, D.D.S. 145
Selection of Teeth N. L. Zimmerman, D.D.S. 424
Septic Wheel Brush, The "R. R. C." 148
Shall we Discontinue Devitalization? Walter S. Kyes, D.D.S. 207
Shoulder Crown and Its Technic Francis C. Jones, D.D.S. 643
Something Different Edward T. Brunson, D.D.S. 364
Specific for Poison Oak or Ivy F. L. Dung.\n, D.D.S. 365
Splint, an Intermaxillary George Morris Dorrance, D.D.S. 645
Successful Deer Hunt in Massachusetts Charles L. Twichell, D.D.S. 380
Sugar and Its Effect Upon the Teeth John S. Engs, D.D.S. 146, 212
Sure Cure and a Pleasant One L. P. Larson, D.D.S. 381
Technic of Natural Tooth Bleaching in the Mouth Louis Englander, D.D.S. 215
Technic for Making Gold Crowns for Posterior Teeth in Mouth WTiere the Bite is
Very Close Raymond S. Scovil, D.D.S. 143
The Beach or Mountains? L. M. Zimmerman, D.D.S. 372
The Dentist, The Patient and Oral Prophylaxis Joseph H. Kauffmann, D.D.S. 760
The First Night in the Woods Paul S. Coleman, D.D.S. 360
Things That are Said in Dental Journals Hillel Feldman, D.D.S. 219
To Separate Gold from Platinum S. M. Myers, D.D.S. 427
Treatment of Fractured Jaws William C. Mogh, D.D.S. i
Trip Registering the Western Attitude to Anatomical Articulation
Dayton Dunbar Campbell, D.D.S. 79
Up the Oswegatchie After Trout H. O. Brown, D.D.S. 405
Valuable Suggestions in Training Assistants Reported by J. E. Waterbury, D.D.S. 495
Value of Oysters 708
Week at Lake Geneva, Wis Elberg N. Johnson, D.D.S. 359
What a Vacation Did for Me J. H. Bltins, D.D.S. 366
What I Like About My Dentist "CD. B." 18
Why a Vacation and Where J. A. McPhail, D.D.S. 394
Why Discard the Tooth Brush? Ernest C. Dye, A.B., D.D.S. 280
Digitized by
Google
TABLE OF CONTENTS, 1916
BUSINESS BUILDING ARTICLES
Advice to Those About to Wear Artificial Teeth 249
Agreement to Surrender Practice Arthur L. H. Street 510
Always Render Your Best Service 451
Answer to a Request for Advice 235
Answers to "B. C. G." 794, 795
Around the Table 790
Brother Bill's Letter 33
Business Side of Dentistr\' 239
Business Side of Prophylactic and Restorative Practice
\V. F. Spies, D.D.S., and George Wood Clapp, D.D.S. 19, 94, 435
Can He Prove It? 453
Canadian Dental Association 709
Commercialism and Dentistry Frank L. Platt, D.D.S. 577
Codperation 658, 659
Costs of Conducting Dental Practice L. W. D. 721
Dentistry from a Financial .Vspect Pkrcy A. Ash, D.D.S. 160, 165
Dentists' Office Hours 241
Dollars, The 1914 and 1915 308, 309
Employment of Unlicensed Assistants .\rthitr L. Street 580
Ethics as It is Lived J. F. Conover, D.D.S., 787
Fees, How Can You Raise, and Keep the Good Will of a Community? 450
Fees, Professional I. J. Dresch 719
Fifty-fifty W. F. DA\as, D.D.S. 296
Getting the Money 52
How Can He Better Conditions? **E. S. G." 27
How to Make a Dentist Happy 238
How to Make and Save a Competency for Old Age *'N. W. D." 22
"Josh," A Reply to, in March Digest "R. L. S." 310
"Josh" Comes Back 171
Layman's Viewpoint, A Katharine Dodge 648
Living Costs and Dental Fees L. W. Dunham, D.D.S. 574
My Way of Figuring the Cost of an Inlay "C. A. G." 31
Necessity for Keeping Complete Records C. Charles Clark, D.D.S. 300
Practical Illustration of Success "C. F." D.D.S. 506
Professional Denture Service — Professional Denture Fees L J. Dri-:sch 719
Relation of the Dentist to the Manufacturer and Dealer Guy Morgan, D.D.S. 584
Reply to M. F. R "H. K," 29
Request for Advice iii
Saving for the Rainy Day and Old Age Fund " A. H." 517
Sellmg Denture Service I. J. Dresch 303
Some Thoughts on the Business Side of Practice D. R. Phelps, D.D.S. 722
State of Michigan, Supreme Court 725
Successful Practice of Dentistry Wallace Secxombk, D.D.S. 444, 5x1
System of Dental Book-keeping F. Z. Ros{>, D.D.S. 103
The Whole World is a Big Store 449
What do you Believe? L. W. Dunham, D.D. S. 793
What I Think Inlays Cost "F. D. H." 98
What Shall we Charge for Plates? W. J. Holrovd, D.D.S. 226
Where Have my Profits Gone? Nils Juell, D.D.S. 308
Who is Responsible for Low Fees? C. Wayne Mingle, D.D.S. 516
Why I Think it Pays to be Courteous "A. B. D." 5x4
Digitized by
Google
▼i TABLE OF CONTENTS, 1916
PRACTICAL HINTS
PAGE
A Gasoline Soldering Outfit 245
A Good Probe 108
A Good Temporary Filling 454
A Kink Worth Knowing in Mending Rubber Plates 5^3
A Laboratory Hint 1 50
A Loose Pin Banded Crown Especially Adapted for Upper Lateral Incisors 244
A Method for the Correct Application of Davis Crown to Roots 114
A Method of Applying Arsenical Paste 38
A New Method of Handling Undercuts in Making Metal Plates 314
A One-Mix Investment for Small Repairs 307
A Painless Way to Open a Sore Tooth 113
A Porcelain Jacket Crown 177
A Time Saving Hint 99
A Useful Application for Sore Lips While Operating 244
An Ordinary Hail Screen 113
Adapting Upper Dentures 732
Aid in Soldering 292
An Abscess Lancet 30
An Aid in Making Large Plumpers 145
Burning Out Wax 454
Dissolving Impression Plaster 295
Extracting a Post From a Frail Root 40
Facilities for Removing Teeth from a Rubber Plate 99
Following the Preparation ©f a Bridge Impression 589
For Quick Devitalizing 731
For Cases of Gengivitis 799
For Sensitive Root Canal 313
For Sound Teeth, that are Sensitive at the Neck 798
Heater for Water and Spray Bottles 732
How to Remove Broken Instruments 245
Hypodermic Syringes 246
Leaky Vulcanizer 176
Making Mould (in Ring) Stick to Casting Machine While Casting 588
Method of Holding Inlay for Polishing 522
Method of Separating and Regaining Space Where Teeth Have Been Lost for Some Time 39
Methods of Relieving Pain While Operating ^i^
Methods to Facilitate the Attachment of Gold Castings to Steele's Backings 31a
Mixing Amalgam ^2,
Nature's Own Anesthetic -j^
Plate Quickly Repaired ^-j
Polishing Crowns -j2
Preventing the Cracking and Bleeding of Chapped Lips ^ j .
Removing Steele's Facings ^2
Rendering Cork Stoppers Impermeable
Repairing a Broken Goslee Tooth
Repairing Plaster Casts
Repairing Punctures in Rubber Dam after Adjusting
Removing Broken Broach from Root Canal
Root Canal Filling r^
Root Canal Filling Material
Ruga •••*•'*'' '*^*!'!;;^ ^ 5^
Rugae on Plates . ^
^ 176
Digitized by
Google
TABLE OF CONTENTS, 1916 vH
PAGE
Securing Brightness in Aluminum Rubber Plates 317
Sq)arating Modeling Compound Impressions 178
Simple Assortment of Casting Rings 454
Simple Method of Altering Seamless Crown Dies 313
Simple Procedure in Antrum Operation 588
Strengthening Plaster Models 178
The Correct Method for Manipulating Amalgam 731
TTiree Hints That I Find Practical 38
To Avoid Bubbles in Casting 544
To Qean a Glass Slab of Cement 176
To Do Away With the Very Much Complained o^ Bellows to Splcicrin;5 Outfit 177
To Facilitate Waxing Parts of Broken Vulcanite'Plates ToiJelher ..'/... 177
To Finish a Silicate Filllin^. I . . ., * .'..'**.*/. ' . . - ~. . v-t^ .:• .•;-752/
To Flow Solder Easily :;:.J.VV :.\.l<.\ . . .\ '.^.i .:. . ] iff
To Get Proper Results When Uaag Synthetic Porcelain in Pra.ximal Occlusal Cavities
in Bicuspids and Molars •:*<•: 312
To Grind Natural Teeth Painlessly '..... .\ ^: .^-: . . 177
To Make a Beautiful Plate 314
To Make a Two Piece Shell Crown Serve as Bridge Abutment 176
To Make Over an Old Bur 454
To Open Hypodermic Needle 798
To Prevent Saliva from Getting Into the Handpiece 522
To Prevent the Softening of Carving Compound in Metal Plates 314
To Prevent Thumb-Sucking in Children 39
To Remove an Inlay Model 114
To Remove Richmond Crown 522
To Repair a Hole in a Bicuspid or Molar Crown 113
To Repair Gold Crowns 245
To Replace Pin Facing on a Bridge Which Has Post Abutments 588
To Restrict the Flow of Solder 178
To Save Time During the Use of Silicate Cements 302
To Splice an Engine Cable 312
To Stop a Leaky Vulcanizer 176
To Stop a Leaking Vulcanizer 454
To Tighten Old Plates 113
Useful Hints 178
Use for Worn Joe Dandy Stones or the Knife Edged Stone With Hub in the Centre 522
Vaseline an Aid in Swaging Shell Crowns 720
Water and Teeth 40
WaxedSilk 108
When Glower Bums Out in the Dentiscope Lamp 1 14
QUESTIONS AND ANSWERS TO PRACTICAL HINTS
41, IIS, "6, 179, 180, 246, 316, 455, 523, 733, 734, 799, 300, 301
DIGESTS
Artificial Teeth, Advice to Those About to Wear D. W. Barker, D.D.S. 249
Conversation 182
Codperation Between the Dentist and the Orthodontist 459
Dental Surgery 803
Emetin vs. Surgery in the Treatment of Pyorrhea Thomas N. Hartzell, D.D.S., M.D. 666
Extragenital Chancres 183
Food Consumption of Adolescent Boys 802
Gift to Dental School 642
Digitized by
Google
▼iii TABLE OF CONTENTS, 1916
PAGE
High Cost of Living 804
Infection of the Hands and Fingers of Physicians 183
Management of Children and the Treatment of Teeth 416
Nature, Manner of Conveyance and Means of Prevention of Infantile Paralysis
Simon Flexner, M.D. 591
Oil of Turpentine as a Haemostatic G. Grey Turner, M.D., F.R.C.S. 182
Partial Dentures W. E. Cummer, D.D.S. 526
President Butler Appeals for $1,000,000 to Endow Columbia Dental School 458
Preventive Dentistry and the Dental Nurse Woods Hutchinson, M.D. 529
Proposed Statement of Aims and Objects -. 247
Spare the Toothbrush ^jlbB'fiie^inlJj .-^* : •. . . : Woods Hutchinson, M.D. 527
The Blaster : . •*.; .;:\ / .V •...:.: ...•; i8a
♦. .* •:• : «:: :*.: "• \ / • •:: • aocrExf «oVe& ■
Alabim& tTen\aI Association .*^' . .*.* ^.^ , 203, 271
American In9d^^*v^IDBeA!41^eacher». . /^ .*2* 5* i ■ •^^ -• • ^ ^^» ^^3
Arizona SoEiKl^r^ioial Eikhuners.^I .".'.** .1 . .^^ * . sh^. . 271
Arkansas State Board Dental Examiners 823
Arkansas State Dental Association 203, 339
California Board of Dental Examiners 339, 823
Colorado State Dental Association 339
Connecticut State Dental Association 271
District of Columbia, Meeting of Examination Board 67
Florida State Dental Society 203, 271, 340
Georgia State Dental Association 271, 340
Idaho State Dental Association 271
Illinois State Dental Society 203, 207, 340
Indiana State Dental Association 271, 340
Iowa State Board of Dental Examiners 823
Iowa State Dental Society 203, 271, 340
Kentucky State Dental Society 271, 340
Lake Erie Dental Association 203
Louisiana State Dental Society 273
Maine Dental Society 340
Mar>'land State Dental Association 203
Massachusetts Dental Society 203, 207
Michigan State Board of Dental Examiners 203, 207, 340
Minnesota State Dental Association 67, 823
Mississippi Dental Association 203, 207
Missouri State Board of Dental Examiners 340
Montana State Board of Dental Examiners 341 , 823
National Dental Association 137, 287, 409, 480
Nebraska State Dental Society 203, 272, 341
New Jersey State Dental Society 341
New York College of Dentistry, Semi-Centennial 410
New York State Dental Society 203, 272, 341
Northern Ohio Dental Association 341
North Carolina State Board of Dental Examiners 67, 823
North Dakota State Board of Dental Examiners 67
Odontological Society of Western Pennsylvania 204, 272
Ohio State Dental Association 823
Pennsylvania Board of Dental Examiners 272, 341, 823
Rhode Island State Board of Registration 341
Sixth District Dental Society of New York 203
Digitized by
Google
GSNERAL INDEX FOR 1916
South Carolina State Dental Association 204, 272
South Dakota State Board of Dental Examiners 67, 823
Tennessee "Board of Dental Examiners 34^
Texas State Dental Association 204, 272, 341
Tri-State Post Graduate Dental Meeting (Missouri, Kansas, Oklahoma) 203
Vermont Board of Dental Examiners 272, 342
Washington University Dental Alumni Association 67
West Virginia State Dental Association 204, 272
Wisconsin State Board of Dental Examiners 204, 272, 342
Wisconsin State Dental Society 67, 272
EPITOME OF CURRENT DENTAL AND MEDICAL UTERATURE
42-65, 117-136, 184-202, 251-270, 464-477, 534-553, 590, 607-618, 663-665, 672-688, 805-821
MISCELLANEOUS
Obituaries 66, 136, 336, 477
Book Reviews 66, 607, 689, 822
Correspondence
8, 92, 93, "2, 174. 175, 241, 242, 31 1, 315, 531, 572, 641, 653, 654, 660, 661, 729, 730, 783, 784
Future Events 67, 137, 205, 273, 343, 410, 482, 552, 620, 690, 756
INDEX BY MONTHS
January 1-68 July 413-482
February 69-138 August 483-552
March 139-206 September 453-620
April 207-274 October 621-690
May 275-342 Nov-EicBER 691-756
June 343-412 December 757-824
GENERAL INDEX FOR 1916
VOLUME xxn
A
A Biblical Quotation 730
A Delightful Camping Trq) 370
A Delightful Vacation and Some Conclusions 362
A Good Tunc in Pocahontas County, W. Va 384
A Launch Trip 386
A Specific for Poison Oak or Ivy 365
"A. B. D." 514
A Slam or an Earnest Proposition? 433
Adams, F. L., D.D.S 311
Advice to Those About to Wear Artificial Teeth 249
Agreement to Surrender Practice 510
"A. H." 517
Alaska Dental Society 453
Alien, Dr. J 153
Always Render Your Best Service 451
Amalgam Ktetorations, Accuracy in 562
An April Vacation 368
An Internuuriliary Splint 645
An Outing In the Ozarks 385
Answer to a Query 243
Answer to a Request for Advice 235
Answers to "M. F. R." 30, 31
Digitized by
Google
X GENERAL INDEX FOR 1916
PACE
Answers to " Perplexed" 434
Angina, Ludwig^s 483
Are State Dental Laws Reasonable? 710
Army Dental Corps, New Legislation Affecting 481
Around the Table 790
Articulation, Perfect, in Posterior Bridgework by Use of Trubyte Molar Blocks 295
Artificial Dentures, Finishing Process of 422
Ash, Percy A^D. D.S 100, 165
Assistants, Training, Valuable Suggestions in 495
Assistants, Unlicensed Employment of 580
Association of Commerce 463
Avoid Appetizers 28
B
" B " 452
Bachelor, O. D 660
B. A. G 794
"B. A. J." 237
Banquet to Mr. Thomas Forsyth 781
Barker, D. W., D.D.S 249, 782
Barnard, Floy Tolbert 345
"B. C. G." 651
Beach or Mountains? 372
Bebyia, F. S., D. M. D 782
Better Doctoring for Less Money 581
Bogue, E. A., M.D., D.D.S 631, 691, 757
Bookkeeping, System of Dental 103
"Boston" 112
Braucher, Olga Thimme 533
Brother Bill's Letter 33
Brown, Edward F., D.D.S 284
Brown, H. O., D.D.S 405
Brunson, Edward T., D.D.S 364
Buckley, J. P., D.D.S 89
Bulletin of the Association of Military Dental Surgeons 730
Bums, J. H., D.D.S 366
Business Side of Dentistry 239
Business Side of Restorative and Prophylactic Practice iQ* 94i 435
C
Cabot, Richard C, M.D 581
" C. A. G." 31
California State Dental Association, Bulletin of the 505
Campbell, Dayton Dunbar, D.D.S 79
Can He Prove It? 453
Canadian Dental Association, 1916 709
Caries — Repairing Carious Teeth 642
Caution 311
Cazier, Marion Howard, M.D 553, 775
" C. F." 506
Chamberlain, L.A., D.D.S 172
Chancres, Extragenital 183
Change of Color 516
Ch&teau de Passy 717
Digitized by
Google
GSNERAL INDEX FOR 1916 zi
PAGE
Christopher, C. R., D.D.S 393
Oapp, Geoige Wood, D.D.S 19, 94, i59, 435
Clappison, O. S., D.D.S 601
Clark, C. Charles, D.D.S 300
"Clinic," Meaning of the Word 782
Closed Mouth Impressions 4» 74, i39, 290, 413, 498, 597, 700, 763
Closure of Jaw in Mastication 502
Clyde Davis, D.D.S 221
Coffin, A. Bruce, D.D.S 293
Cole, Walter S., D.D.S 370
Coleman, Paul S., D.D.S 360
Columbia, $125,000 for 795
Columbia Dental School, President Butler Appeals for $1 ,000,000 to Endow 458
Colyer, J.F 494
Commercialism and Dentistry 577
Complete Description of My Most Successful Operation 627
Conditional Sale of Dental Fixtures and Furniture 15
Conovcr, J. F., D.D.S 787
Conservative and Constructive Treatment of Riggs* Disease 775
Conversation 182
Cooperation 658, 659
Cooperation Between the Dentist and the Orthodontist 459
Correct and Incorrect Cuspid Relations 561
Cost of an Inlay, My Way of Figuring 31
Costsof Conducting Dental Practice 721
Cotton Brigade 520
Court Decision, Appellate, on Some Points of Interest in Dental Laws and Their En-
forcement 460
Cow-Bell Method of Casting Aluminum Bases 416
" C. S. L." 1 74
Cunmier, W. E., D.D.S 526
D
Davis, W.F., D.D.S 296
Deacon, A. P., D.D.S 351
Deciduous Teeth, Orthodontia of the 631, 691, 757
Dcmarest, H. M., D.D.S 627
Dental Economics 587
Dental Hygienists 284
Dental Laws, Decision in 460
Dental Nurse, Preventive Dentistry, and the 529
Dental Protective Association, Important Information from the 85
Dental Protective Associations? Why are There Two 288
Dentistry Among the Troops on the Mexican Border 630
Dentistry from a Financial Aspect 100, 165
Dentists' Office Hours 241
Dentures, New Method of Constructing Full 221
Detachable Cusp for Steele's Facings 700
Devitalization, Shall we Discontinue? 207
Dinshah Dadabhai Dordi ^33, 784
Do You? 557
Do You Know That? 644
Dodge, Elatharine 448
I>resch, L J 303, 719
Digitized by
Google
xii GENERAL INDEX FOR 1916
PAGE
Dungan, F. L., D.D.S 365
Dunham, L. W., D.D.S 514, 710, 793
"D. W. B." 434
D. W. H 432
Duplicates of Dental Publications at Vanderbilt University 718
Dye, Ernest C, A. B., D.D.S 280
E
Efficiency of Tmbyte Teeth 243
Eighth Annual Hay Fever Pilgrimage 402
Eldridge, Watson, W., M.D 155, 277, 621, 398
Emetin vs. Suigery in the Treatment of Pyorrhea 667
Emplojonent of Unlicensed Assistants 581
Englander, Louis, D.D.S 215
Engs, John S., D.D.S 146, 212
" E. S. G." 27
Ethics as It is Lived 787
Evolution of a Prosthodontist 6
P^xodontia under Nitrous Oxide and Oxygen Anesthesia 769
Experiments to Determine the Toxicity of Therapeutic Agents in the Treatment of Py-
orrhea on Animal Cells Grown in Vitro 69
F
Failure to Sterilize Instruments as Malpractice 652
Faison, C. I., D.D.S 30
Fate of An Innocent Bystander 345
Fatigue, Cause — Nature and Cure 398
"F. D. H." 98
Fees, Dental 574
Fees, How can you Raise, and Keep the Good Will of the Community 450
Fees, Professional Denture Service, Professional 719
Feldman, Bernard, D.D.S 219, 485
Fifty-fifty 296
Finishing Process of Artificial Dentures 422
First Night in the Woods 560
Flexner, Simon, M.D 591
Food for Dentists 155,277,621
Forsyth, Thomas, Banquet to 781
Forsyth Infirmary for Children 342
Forsyth Loving Cup, Hartford Men Contribute to 220
G
GaUie, D. M., D.D.S 89
Gamble, B. L., D.D.S 385
Getting the Money 452
Gift to Dental School 642
Gillock, CM., D.D.S 315
Gold Crowns for Posterior Teeth in Mouth where the Bite is Vcr>' Close 143
Gold SheD Crown and Post for Short Teeth 455
Great National Movement 9
H
Hartzell, Thomas B., D.D.S 666
Haskell, Loomis P., D.D.S 502, 716, 778
Healy. T. G., D.D.S 422
Digitized by
Google
GENERAL INDEX FOR 1916 ziu
PAGE
Higgason, J. C, D.D.S 39©
HiU, E. W., D.D.S 384
Holroyd, W. J.,D.D.S 226,640
Homer, H. J., D.D.S 640
How Can He Better Conditions? 27
How to Make and Save a Competency 22
"H. K." 29
Howe, Perry R., D.D.S 782
Hunting with Airedale Terriers 351
HunUey, CarroU, C, D.D.S 477
Hutchinson, Woods, M.D 527, 529
Hygienists, Dental, First Course for the Training of, in New York 503
Hygienists, Dental 284
Impacted Third Molar Causes Facial Paralysis 566
Importance of Suggestion in Dental Practice 724
Impressions, Closed Mouth 4, 74» i39> 290, 413, 498, 567, 700, 763
Indictment Against Dentist Quashed 223
Infection of the Hands of Physicians 183
Inlays Cost, What I Think, 98
"Investing for the Rainy Day " 652
J
Jaulusz, H. J., D.D.S 217
Johnsen, Elberg V., D.D.S 359
Jones, Francis C, D.D.S 643
"Josh ", A Reply to, in the March Digest 310
"Josh" Comes Back 171
"J.S." 220
Juell, Nils, D.D.S 293,308
K
Kauffmann, Joseph H., D.D.S 760
Keyes, Frederick A., D.D.S 782
Kurlander, J. E., D.D.S 219
Kyes, Walter S., D.D.S 207, 572
Larson, L. P., D.D.S 381
Launch Trip, A 386
Lay, Victor, D.D.S 145
Layman's Viewpoint, A 648
Lee, W.B., D.D.S 368
Letter to a Dentist, An Original 158
Liquid Petroleum 606
"L. L." 175
Living Costs and Dental Fees 575
"L. R." 434
Ludwig's Angina 483
Lupton, L. A., D.D.S 386
M
MacKenzie, Chas. M., D.M.D 625
McChesney, C. J., D.D.S 640
Digitized by
Google
xiv GENBRAL INDEX FOR 1916
PAGE
McClelland, W. Clyde, D.D.S 416
McCormlck, Vance C 573
McPhaU, J. A., D.D.S 394
Marco, B. Banymore, D.D.S 566
Marsh, W. E., D.D.S 784
"Massachusetts" 112
Mastication, Closure of Jaw in 502
Miller, J. M., D.D.S 90, 91 , 376
M. L. C 795
Mingle, C. W., D.D.S 516
Mogh, WiUiam C, D.D.S i
Molar Blocks, Trubyte 294
Morgan, Guy, D.D.S 584
Mouth Washes, Problem of 625
Musings of a Simpleton 656
My Quest for Pike 354
Myers, S. M., D.D.S 427
N
Nathan, Charles, D.D.S 575, 724
National Dental Association, Twentieth Annual Session 409
National Dental License Association 728
Natural Cleansing of the Mouth by Natural Means 485
Nature, Manner of Conveyance and Means of Prevention of Infantile Paralysis 591
New Method of Constructing Full Dentures 321
Nitrous Oxide and Oxygen Anesthesia, Exodontia Under, 769
"N. J." 31
" N. M. D." 22
O
Obturators, Adjusting 217
Ohm, W. H., D.D.S 239
Oral Prophylaxis, The Dentist, the Patient and, 760
Orthodontia of the Deciduous Teeth 631 , 691, 757
Orthodox Orientals and Their Freedom from Pyorrhea Alveolaris 531
Our Vacation in 1915 390
Our Wisconsin River Trip 374
P
Partial Dentures 526
Patient Frankly Leaves the Reward to God 241
Perkins, Bertram R., D.D.S 769
"Perplexed" 220
Phelps, D. R., D.D.S 722
Phillips, M. G., D.D.S 763
Platinum, Separating Gold From 427
Piatt, Frank L., D.D.S 577
Practical Illustration of Success 506
Practice, Business Side of Prophylactic and Restorative 19
Pray, K. D., D.D.S 294
Preventive Dentistry and the Dental Nurse 529
Prime, J. M., D.D.S 222
Problem of Mouth Washes 625
Professional Denture Service or Professional Fees? 719
Professional Discourtesy 431
Digitized by V:iOOQIC
GENERAL INDEX FOR 1916 zv
PAGE
Progressive Prosthetic Clinic 705, 707
Proof of Malpractice in Dentktr>' 234
Proposed Statement of Aims and Objects 247
Pyorrliea Alveolaris, Orthodox Orientals and Their Freedom From 531
Pyorrhea and the General Health 641
Pyorrhea, Treatment of, for the General Practitioner , 601
Q
QUESTIONS AND ANSWERS .... 41, 115-116, 179, 246, 315, 455-457, S23, 59©, 663, 733
R
Rafidin Ahmed, D.D.S 786
Rapid and Accurate Method of Soldering Pin to Richmond Cap 565
Rationale of Riggs' Disease 553
Records, Necessity for Completing Complete 300
Rdd, J. G., D.D.S 89
Relation of the Dentist to the Manufacturer and Dealer 584
Repairing Carious Teeth 642
Reply to "M. F. R." 29
Richmond, Harvey. D.D.S 642
Robertson, T. M., D.D.S 402
Ross, F. Z., D.D.S 103
"R. R. C." 148
Rugae 145
S
Saving Time in Impression Taking, 786
Saving for the Rainy Day and Old Age Fund 517
Scovil, Raymond, D.D.S 143
Seccombe, Wallace, D.D.S 305, 444, 511
Selection of Teeth 424
Selling Denture Service 303
Separating Gold from Platinum 427
Septic Wheel Brush, The 148
Shearer, William L., D.D.S 172
Sherman, W. Goddard, D.D.S 149, 562
Shortage of General Practitioners 78
Shoulder Crown and Its Technic 643
"S. H. W." 786
Some Thoughts on the Business Side of Practice 722
Something Different 364
Spare the Toothbrush, Spoil the Joints 527
Specific for Poison Oak or Ivy 365
Spence, Stewart J., D.D.S 491, 557
Spies, W. F., D.D.S 19, 69, 94, 159, 435
Splint, An Intermaxillar>' 64S»
Stein, J. J., D.D.S 521
Stekl, C. F., D.D.S 374
Street, A. L. H 234, 310, 510, 552, 580
Strong Man's Song 552
Successful Deer Hunt in Massachusetts 380
Successful Practice of Dentistry 305, 444, 511
Sugar and Its Effect Upon the Teeth 146, 212
Suggestion in Dental Practice, Importance of 575
Digitized by
Google
zvi GENERAL INDEX FOR 1916
PAGE
Supplee, Samuel G 4, 74, i39» 290, 413* 498» 567,- 700, 764
Sure Cure and a Pleasant One 381
System of Dental Bookkeeping 103
T
Taggart Cannot Sue the Dentists Collectively 504
Taylor, L. C, D.D.S 661
Tench, Russell W., D.D.S 561
The Beach or Mountains? 372
The Blaster 180
The Fate of An "Innocent Bystander" 345
The Whole World is a Big Store 449
Too Busy to Read 206
Tooth Bleaching, Technicof Natural, in the Mouth 215
Tooth Brush, Care and Use of the 222
Tooth Brush? Why Discard the 280
Towne, Wm. E., D.D.S 237
Treatment of Fractured Jaws 4
Trubyte Molar Blocks, Perfect Articulation in Posterior Bridgework by the Use of 294
Turner, G. Grey, M. S., F. R. C. S 182 .
Turpentine, Oil of, as a Haemostatic 182
Twichell, Charles L., D.D.S 380
Two T>'pical American Faces 573
U
Uncle Mack 452
University Dental School in New York for Columbia 225
Up the Oswego After Trout 405
V
Valuable Suggestions in Training Assistants 495
Vulcanite, Expansion and Contraction in Plaster and 491
AV
Walters, W. S., D.D.S 354
"Washington ** 112
Waterbury, J. E., D.D.S 495
Weaver, C.W., D.D.S 362
Webster, Guy B., D.D.S 504
Weed, Thomas M., D.D.S 655
Week at Lake Geneva, Wisconsin 35v
Weeks, Sinclair, D.D.S 6
What a Vacation Did for Me 366
What Do You Believe? 793
What I Like About My DenUst 18
What I Think Inlays Cost 98
What Shall We Charge for Plates? 226
Where Have My Profits Gone? 308
Why a Vacation and Where 394
Why I Think It Pays to be Courteous 514
Who is Responsible for Low Fees? 576
Willcox, W.R 573
Woodle, J. M., D.D.S 565
Wrongful Discharge of Dentist 151
Z
Zimmerman, L. M., D.D.S *. 424, 372
Digitized by
Google
The Dental Digest
GEORGE WOOD CLAPP, D.D.S., Editor
Published monthly by The Dentists' Supply Company, Candler Bldg.,
Times Square, 220 West 42d Street, New York, U. S. A., to whom all com-
munications relative to subscriptions, advertising, etc., should be addressed.
. Subscription price, including postage, $1.00 per year to all parts of the
United States, Philippines, Guam, Cuba^ Porto Rico, Mexico and Hawaiian
Islands. To Canada, $1.40. To all other countries, $1.75.
Articles intended for publication and correspondence regarding the same
should be addressed Editor Dental Digest, Candler Bldg., Times Square,
220 West 42d Street, New York, N. Y.
The editor and publishers are not responsible for the views of authors ex-
pressed in these pages.
Entered as Second Class Matter, at the Post-Ofl5ce at New York City.
Under the Act of Congress, March 3, 1879.
Vol. XXII
JANUARY, I9I6
No. 1
TREATMENT OF FRACTURED JAWS
William C. Mogh, D.D.S., Brooklyn, N.Y.
Case I
Patient — Mr. N. Age — 50 years.
History — ^Was kicked in the face by a horse, causing a compound frac-
ture of the superior maxilla. Was admitted to the Williamsburg Hos-
pital, Brooklyn, on July 6th, 1915, in the service of Dr. Robt. Morrison,
visiting surgeon.
I was called in on the case by the hospital and found the patient in
great pain. He had a temperature of 105 and his mouth was a mass of
splintered bone, process and pus. It took fifteen minutes of steady
irrigation to get the mouth in a condition before I could see anything at
all. Upon close examination I foimd the patient to be suffering from a
compound fracture of the upper maxilla, one break being between the
lateral incisor and canine of the right side, and the other between the
lateral incisor and canine on the left side. He had also a simple fracture
of the mandible on the right side, between the first bicuspid and the
canine.
In Figure i we have a diagram of the fracture in the superior maxillae.
The pain from touch was so great, that the patient had to be taken to
the operating room, where I took the impression, first having wired the
Digitized by
Google
2 THE DENTAL DIGEST
case, to be sure the parts would not move when the material was forced
in. From this impression I made a rubber splint which besides covering
the teeth from the one first bicuspid to the corresponding tooth on the
other side, also covered the palatal surface of the bone, and held the parts
tightly in their normal relationship.
The fracture of the mandible was a simple one as is shown in Figure 2.
Fig. I. Showing fracture of superior maxilla
Fig. 2. Showing pK)int of fracture
I took the impression with modeling compound, holding the two parts
together. From the model of the impression the gold splint was swaged
and then cemented on.
The case was dismissed in sixty days, when the patient was able to
use his mouth as he had done before the accident.
Digitized by V:iOOQIC
TREATMBNT OF FRACTURED JAWS 3
Case II
Patient — ^J. Age — 7 years.
History — Was run over by a wagon causing a fracture on the right side
of the mandible. Was admitted to the Williamsburg Hospital, Brooklyn,
on October i6th, 1915, in the service of Dr. Robt. Morrison visiting
surgeon.
Being called upon to take charge of the case I immediately looked for
crepitis, which I found on the right side of the mandible, as is shown in
Figure i.
Fig. I, Case 2. Showing the point of fracture
T. Temporary molar; 2. Temporary molar; 3. Temporary canine or cuspid; 4. Perman-
ent lateral incisor; 5. Permanent central incisor; 6. Point of fracture.
Fig. 2, Case 2. Showing gold splint in place
I. Gold splint in place cemented to the teeth; 2. • Fracture in perfect contact.
It being a case of a simple fracture, I took an impression in modeling
compound, being very careful to have my assistant in the case hold the
jaw at the angle and the chin, making certain that there would be no
chance of the patient moving and getting an incorrect impression. I
then took a bite with soft wax to get good occlusion. The models were
then made from the impression and bite, and from the model the splint
was swaged, and then soldered, making a continuous gold splint, as is
shown in Figure H.
In thirty-three days I took off the splint, and the patient had once
more a perfect jaw and bite.
223 St. Nicholas Ave.
Digitized by
Google
4 THE DENTAL DIGEST
CLOSED MOUTH IMPRESSIONS
By Samuel G. Supplee, New York
First Article
certain preliminary considerations
When I was graduated from dental college to practical work, plaster was re-
garded as the only proper material for taking impressions. After a year of
partial successes mixed with some complete failures, I met a dentist who had
learned how to whittle and scrape models so that plates made over them would
stay up. I lunched with a denture patient once and was mortified to see him
take out his plates "so he could eat."
I spent some years in the study of anatomical articulation without giving
much thought to the impressions. Those who followed the published methods
achieved better success than before, but certain failures of the dentures, not
connected with articulation, were discomforting. I know now that those fail-
ures originated in faulty impressions, bites, and models.
Then Mr. Supplee showed me things about impressions, of which I had
never dreamed. I saw that the best articulated dentures might fail from unsci-
entific impression taking and cast making methods. I saw him succeed with
case after case where I should have stood no chance of success. Sometimes he
had to try more than once, but he succeeded where from 5 to 15 dentists failed.
And he succeeded because he has learned how to take impressions and bites
and pour models and arrange teeth and vulcanize in a scientific manner,
I am very glad to have the opportunity of bringing the fruits of Mr. Supplee's
work to the readers of this magazine. I am sure that those who follow his
methods will achieve greater success than by any other methods I know of.
When the methods in all steps of denture making become scientific, we shall
regularly achieve as great successes in this field as in operative work. We shall
then be much better dentists and shall more nearly fulfil our mission of render-
ing good service to edentulous patients. — Editor.
The phrase "taking an impression and pouring a cast" has, for years,
indicated practically all there was to be said of the technic of preparing
a foundation on which a plate is constructed.
'* Fitting a plate " has been the expression to describe the hours of filing
and trimming after the plate has been vulcanized.
It has been well said that denture making by the old methods has
been mostly guesswork, and that the honors have usually gone to the
best guesser, or to him who was most skillful with scraper, stone or file.
The arrangement of the teeth by the old methods of occlusion and on the
old forms of articulators has also been mostly guesswork.
Among the questions which confront those who wish to do really pro-
fessional service in dentures are the following: — Shall we aim to obtain
impressions of the mouth from which to construct dentures in the usual
way, or shall we construct in the mouth trial plates which will properly
compress or displace soft tissues and at the same time hold the lips, and
cheeks out to the positions necessary for restoration of expression and du-
Digitized by
Google
CLOSED MOUTH IMPRESSIONS 5
plicate these in the finished dentures? The second question is: Shall we
p)our casts in plaster, which expands and which is easily compressed in the
flask press or by the expanding vulcanite, or shall we pour casts in materials
which are less subject to changes and less likely to defeat our best efforts?
In my article entitled "The Importance of Taking Impressions With
the Mouth Closed and Under Biting Pressure," published in the October
1914 issue of this magazine, I called attention to the difference between
an impression with the mouth open and the mouth closed. Many den-
tists have formed the opinion that the difference between impressions with
the mouth open and the mouth closed constitutes the secret by which
those who have made careful studies of mouths and materials have been
able to make successful dentures for patients for whom all previous den-
tures have been unsuccessful.
Many have gained the idea that all they need to insure success is
water heating apparatus, a set of trays and some modelling compound.
The results of their impressions with closed mouths and properly heated
modelling compound has been that their dentures have been more success-
ful than ever before, but that a certain percentage of these cases has been
successful for only a short time. The temporary nature of these successes
has been due to imperfect conceptions of the mouth, of the materials
employed and the methods best suited to their uses.
In addition to this, they have not grasped the idea that when no pres-
sure is appUed to a plate, it rests on the soft tissues, but when biting pres-
sure is applied, the plate is forced against the soft tissues until they are
either condensed or displaced into positions and conditions in which the
soft tissues and the hard tissues bear the strain equally. This is equal-
izing the tissues to withstand biting strain. The successes mentioned
above were temporary only because of the employment of improper
methods in condensing or displacing soft tissues.
To eliminate guesswork from denture making, one must replace the
rule of thumb methods of the past in impression and bite taking, arrange-
ment of the teeth and laboratory work, with the scientific methods now
offered in all these lines. For instance, both dentists and laboratory
workers will profit by recognizing that plaster begins to expand as soon as
it is set, and is easily compressible, and to the extent that it is affected by
these changes is unreUable. During vulcanization the vulcanite first
expands then shrinks and finally warps. Unless care is exercised to guard
against these changes, our finest efforts may be frustrated by failures due
to change in form of materials.
These changes in form can be guarded against by properly pouring
casts of the non-expanding and practically non-compressible materials
such as Weinstein's Artificial Stone, Spence's Plaster, etc.
Digitized by
Google
6 THE DENTAL DIGEST
In mouths where the muscular attachments are not pronounced and
the vault and ridges are of equal density all over, we can take impressions
in plaster, or any other kind of impression material regardless of the size
of the tray, with the expectation that successful dentures will result.
But even the prosthetic speciaUsts have been obliged to admit that in
cases which present difficulties from character of tissue or of form, model-
Ung compound is far superior to plaster as an impression material.
In this series of articles I shall outline a technic of diagnosing condi-
tions in the mouth, of impression taking and of bite making which has
been successful in many cases where all other forms of techm'c have failed.
(This article is expected to be continued)
THE EVOLUTION OF A PROSTHODONTIST
By Sinclair Weeks, D.D.S., New York
This article was awarded the Fourth Prize in the Prosthetic Articles Contest.
Just before entering college to take up my studies in dentistry, I was
fortunate in meeting a dentist of the old school who was ripe in experience
as well as years, who offered me a few words of advice which must have
burned deeply into my sub-conscious memory for they have stayed by
me for twenty years. They were as follows — *' Young man your success
in this field will largely depend upon whether or not you possess a mechan-
ical sense. If you do you can put it to no better use than to cultivate the
highest degree of skill in the construction of artificial teeth. It takes a
patient from six months to five years to find out what kind of gold filling
you have inserted for him, but it only takes a few weeks to find out if you
have made him a useful set of teeth."
It was a long time before I fully comprehended the significance of that
advice and started out to follow it. After I was graduated and went out
into the world to become acquainted with my chosen profession I found
the majority of dentists had either, through lack of ability or indifference,
pulled or pushed this very important branch of dentistry down to a low
level and belittled it by calling it common plate work and relegated it the
office girl or an outside laboratory. I determined to meet the very first
opportunity which should present itself to allow me to perfect myself
along these lines. Shortly after I went into a laboratory in a small city
with an ethical man to **work out my salvation."
I received some pretty severe jolts in the next few weeks when I saw
many of the important methods of technique which had been quite a
respectable part of my college education thrust aside and in their place a
Digitized by V^OOQIC
THE EVOLUTION OF A PROSTHODONTIST 7
slip-shod trusting-to-luck-method. I was taught that excessive stirring
of plaster caused great expansion, but I saw it mixed here as one would
whip cream. I learned at college that the correct way to take a bite
was to fit plates to casts with a stiff material and build them up with
compound, but here I saw a roll of beeswax thrust between the jaws and
the patient told to bite. I had cause to wonder if there was any standard
of articulation, when I saw teeth set up on the barn door hinge, and when
I finally dared to offer a mild protest, I was told that I was only talking
theory and that plate work in reaUty was very simple and that I would
soon master it, if I cut out the theory and came down to simple practice.
Experience is not only a great teacher, but it plays an important part
in raising our standards. When a year or so later, I started in business
for myself I was glad to be free to carry out some of the ideas which had
been handed down from the men who had gone before and I learned
as we all do sooner or later, that there is no short cut to success. After
trying to take a few short cuts, I got right back to first principles and gave
up the idea that plate work was "simple," I suppose I must have met
with a certain degree of success for business began to come my way and
I began to acquire a reputation as a plate maker. As I look back and
think about the plates, I turned out I am pretty sure it took more skill to
manipulate them than it did to construct them.
As the months went by I began to see the importance of this much
neglected work; in place of drudgery, I saw that if one really possessed a
mechanical sense it became more and more pleasant if not really fascin-
ating. I saw that if one was to consider it serious business it meant care-
ful study of each step of the process in the construction of a plate. That
a perfectly fitting denture was never the result of guess work or luck.
That because a plate might be good enough it was not necessarily just
right. Two important steps I learned were essential, namely — a perfect
impression and a perfect bite. This I held to tenaciously and my per-
severence was rewarded to a satisfying degree. I ajso saw that if I was
to excel I must go a little farther than the other fellow so I began to carve
the gums. I always directed the patient's attention to this and it made a
good impression. I also vulcanized over thin gold foil. This also pleased
patients. I was careful to see that my plates were as thin as consistent
with strength. The next year the Anatomical moulds came on the mar-
ket and this gave me an opportunity to increase prices. I started in to
educate my patients to see that there was a difference in plates, and in-
variably foimd that if the pubUc was made to see by frank honest business
talk that they were getting something better than the ordinary article
they were perfectly willing to pay for it. Occasionally I would meet a
patient who thought plates were plates regardless of how they were made
Digitized by V^OOQIC
8 TH£ DENTAL DIGEST
and would try to induce me to reduce my fee. I held rigidly to my scale
of prices and explained to him that if I attempted to economize he would
be the loser. I recall one man who was in very comfortable circum-
stances and perfectly able to pay, objecting to my prices and leaving
the office, saying he would like to have me do the work but that he wo\ild
never pay that price if he went without teeth all his life. Imagine my
surprise when he returned to my office a year later and told me he had
dedded to have the work done. Two years later I moved to a larger
field with greater opportunities to study improved and up-to-date meth-
ods. I found as I had in the small city^ but in a much greater degree, a
broad and unlimited field with opportunity continually pounding at the
door of the man who could excel in high class plate work. I attended
lectures and clinics and saw prosthetic dentistry advancing by leaps and
bounds. I secured the Prosthetic Articulation and mastered the princi-
ples involved in the Greene-Supplee method of taking compound im-
pressions, I became dissatisfied with trying to fit stock trays, secured a
flask and thereafter cast my own trays.
With the appearance of Trubyte teeth on the market I began to talk
efficiency as well as appearances. Discarding the illogical and out of date
temperamental theory I drew an outline of the face and selected the teeth
according to the Williams classification. By this method I have been
able to select teeth that will harmonize with facial outline. I always set
up the teeth on a Gysi articulator and try them in before vulcanizing. I
finish the upper plate first and insert it to see that the bite is correct with
the lower teeth which are still in the wax. This enables me to secure a
perfect articulation.
At present I carve the gums and insert the rugae. I vulcanize all
plates over Spence's plaster models to eliminate expansion and secure the
necessary strength to resist breakage in the flask. I always take time
(and consider it a most profitable investment) to explain all these ad-
vantages to my patients. I have no trouble to secure satisfactory com-
pensation. I hope the next ten years will see prosthetic dentistry solidly
placed on the high level in the profession where it logically belongs.
Editor Dental Digest: —
What is the best thing to do for a three year old girl who breathes
through the mouth at night and snores as loud as an adult?
The physician says she has no adenoids. She has been breathing and
snoring this way for about three weeks.
W. B. B.
Digitized by
Google
A GREAT NATIONAL MOVEMENT 9
A GREAT NATIONAL MOVEMENT
Objects and Accomplishments of The National Mouth Hygiene
Association result in interesting plans for the future
By W. G. Ebersole, M.D., D.D.S.,
Secretary-Treasurer-General of The N. M. H. A.
When Miss Cordelia L. O'Neill, who was then principal of Marion
School in Cleveland, presented to the National Dental Association at its
meeting in Cleveland in 1911, and later at the Fourth International Con-
gress on School Hygiene, the twenty-seven members of her class as a
living demonstration of what Mouth Hygiene could accomplish, the
establishment of a national association was no longer a question. The
visible evidence of the physical and mental transformation wrought in
those children was greeted by the audience with a demonstration of en-
thusiasm that will never be forgotten by anyone who was present.
The National Mouth Hygiene Association was formed as an auxiliary
of the National Dental Association July 28th, 1911 , in order to unite under
one efficient national organization the various oral hygiene working forces
of the country. It has already a record of achievement of which both
the professional and lay members may justly be proud and which should
enlist the interest and support of the entire dental profession.
Among many laudable motives back of this national movement are
the following, which appear in the preamble to the constitution and by-
laws of the Association, as adopted at a meeting in Washington, D. C,
last May:
1. The teaching of Mouth Hygiene and its relation to better health,
increased mental and physical working efficiency, and consequent greater
happiness;
2. To provide both the expert service and the funds necessary to en-
able the organized dental profession in every community to do those
things that are for the best interests of its people;
3. To direct the attention of parents and guardians to the importance
of dental services especially in childhood;
4. To eliminate the dental fakirs, charletans and fraudulent adver-
tisers who subsist on the ignorance and credulity of the public;
5. To teach Preventive Dentistry and to recommend the employment
of the highest t)q)e of professional services;
6. To promote the efficiency of the organized dental profession in-
dividually and collectively and to give it a wider, more responsive and
more intelligent field in which to work;
Digitized by
Google
10 TH£ DENTAL DIGEST
7. To bring together actively not only the serious workers in the
dental profession, but people of all other professions and vocations, and
to enlist their united interest and cooperation in the expansion of the
propaganda of Preventive Dentistry and Mouth Hygiene;
8. To act as a servant, aid and auxiliary, to both the organized dental
profession and the American public to secure and retain the highest and
most permanent benefits for all, through the realization of the objects
first stated:
The incorporation of the Association under its present title, however,
didn't take place until the annual meeting of the National Dental Associ-
ation at Rochester, N. Y., in July, 1914. It is a corporation not for
profit, and exists, as stated in the paragraphs just quoted, for philanthropic
ends.
There is no question but that the influence of the Association has been
one of the chief forces in bringing about a more enlightened public opinion
on the subject of Mouth Hygiene in its relation to public health.
The importance of the movement has been fully recognized by na-
tional, state and local boards of health, by school boards all over the
country, and by individuals and organizations interested in social wel-
fare, while many of the leading men of the dental profession have given
freely of their time, money and influence.
The responsiveness of the public has been made evident from the very
beginning, not only by the interest shown in public dental clinics, but by
the private donations for their support — notably at Boston, Rochester
and Cleveland. This evidence, together with such encouraging indica-
tions as the extensive welfare work under municipal auspices at New York,
Buffalo, Philadelphia, Detroit and Cincinnati, show the seriousness with
which need of better Mouth Hygiene is regarded.
The Assodation has from the first been identified with related health
organizations. It participated in the Fifteenth International Congress
on Hygiene and Demography at Washington, in 191 2, conducted a special
session at the Fourth International Congress on School Hygiene at Buf-
falo in 1913, and a joint session with the Forty-Second Annual Meeting
of the American Public Health Association at Jacksonville, Fla., in 1914.
When Mr. Taft was President of the United States he recognized the
Association officially, and it has been endorsed by many state and local
dental societies and prominent leaders in education, social and industrial
betterment and general hygiene.
This success of the Association has doubtless been largely due to the
fact that its founders recognized the need of organization from the outset,
and elected a body of officers and a Board of Governors, composed of men
and women whose reputation is a guaranty of an efficient service.
Digitized by V:iOOQIC
A GREAT NATIONAL MOVEMENT 11
The President of The National Mouth Hygiene Association is Dr.
Harvey W. Wiley, the great pure food expert, former chief of the U. S.
Bureau of Chemistry.
Among the vice presidents are Dr. Rupert Blue, Surgeon-General U.
S. Public Health Service, and now President of the American Medical
Association; Dr. W. A. Evans, ex-health commissioner of Chicago, now
editor of the Health Department of the Chicago Tribune; Dr. Oscar
Dowling, President of the Louisiana State Board of Health; and William
R. Malone, President of the Postal Life Insurance Co.
Turning to the Board of Governors we note such names as those of
Prof. Irving Fisher of Yale University, Chairman of the Hygiene Refer-
ence Board; Miss Julia C. Lathrop, Chief of the Children's Bureau of the
U. S. Department of Labor; while Dr. John W. Kerr, Assistant Surgeon-
General, U. S. Public Health Service; Mr. Lewis Meriam, Assistant
Chief of Children's Bureau of the U. S. Department of Labor; Mr. F. B.
Dressier, Specialist in School Hygiene & Sanitation, Bureau of Education,
Department of the Interior, have pledged service in research and exten-
sion work, and several of the U. S. Bureaus have been placed at the dis-
posal of the Association in promoting its propaganda.
The working methods of the Association include extensive campaigns
in different cities for the double purpose of community education and the
raising of funds, a strong dental publicity department which secures wide
publication of all news relating to the movement and many highly educa-
tional articles on Mouth Hygiene; and active cooperation with the work
of allied organizations. One of the great objectives is the establishment
of public dental clinics and school clinics in every town and city.
The prosecution of the work is assisted by the establishment of local
auxiliaries, the Association furnishing the expert service to organize,
finance and equip these auxiliaries in a manner which insures definite
results and continued self -support, and around which can be centred the
work of each community. Auxiliaries have already been formed at
Dallas, Texas; Cleveland, Ohio; Washington, D. C; Portland, Oregon;
Kansas City, Mo.; Dayton O.; Canton, O., and Jacksonville, Fl'a., and
the Association is proceeding as rapidly as possible to place these on a
successful working and supporting basis.
Many other communities have taken steps toward the establishment
of active auxiliaries and may be expected to follow the examples of those
already mentioned. Among them are Louisville, Ky.; Joliet, 111.; At-
lanta, Ga.; Duluth, Minn.; Mobile, Ala., and Lynchburg, Va.
It is with a great deal of satisfaction that we call attention to our De-
partment of Extension Lectures under the supervision of Dr. Edwin N.
Kent (Director of Extension Lectures), Boston, Mass. (330 Dartmouth
Digitized by
Google
12 THE DENTAL DIGEST
St.) This Department is prepared to furnish illustrated lectures suitable
to the various needs of Mouth Hygiene workers of the country. These
lectures with a set of thirty- two (32) slides, which have been very care-
fully selected, are supplied to the organizations or communities desiring
same at a cost of $2.50 plus express charges both ways; thus making it
ix)ssible for Mouth Hygiene workers to have at conmiand this kind of
service at a minimum cost.
It is evident that the Association has imdertaken a great task and is
prosecuting it with remarkable vigor. Raising the funds for establishing
and maintaining such work on a national scale is in itself a large problem.
One of the most important of all meetings of the Association was held
in the city of Washington on May 29th of this year. Many matters
which had been pressing for attention were taken up and measures adopted
which will strengthen the organization and extend its usefulness.
The work of the officers was recognized by their reelection.
The constitution and by-laws were amended to conform to the laws
of the District of Columbia, and to facilitate the completion of the incor-
poration of The National Mouth Hygiene Association as a corporation
not for profit.
The principal action necessary to conform to law in this connection
was the creation of a Board of Trustees — this Board to be fifteen in num-
ber. The thirteen members of the existing Board of Governors, including
the Secretary-Treasurer-General, were appointed to this Board of Trus-
tees, the two additional members being the President of the Association
and the Chairman of the Hygiene & Education Committee of the Na-
tional Dental Association.
It was also necessary to change the formal title of the Secretary-
Treasurer to "Secretary-Treasurer-General."
Further changes in the constitution were made in order to enable the
Association to carry out its purposes and policies; and a preamble to the
constitution was adopted setting forth these purposes and policies as
given at the outset of this article.
The general financial problems of the Association also came up for
consideration and important action taken which is expected in time, to
result in larger and more dependable sources of revenue for the local and
national philanthropic work.
Annual dues of active members were raised from $1.00 to $2.00 and
new methods adopted for the sale and distribution of Mogene Dental
Products.
Many members of the Profession are, of course, familiar with the fact
that Mogene Dental Cream has for some time been manufactured and dis-
tributed under supervision and guaranty of The National Mouth Hy-
Digitized by V:iOOQIC
A GREAT NATIONAL MOVEMENT 13
giene Association, with a binding guaranty that that portion of the pro-
ceeds of sale receipted by the Association shall be devoted to the Na-
tional and local philanthropic work in the cause of Mouth Hygiene.
The Association was led to this action for two reasons; First, because
it realized that here was a logical and effective means of increasing the
. fluids available for prosecution of its philanthropic propaganda. Second,
because it felt the need of a dentifrice which it could conscientiously
recommend to the general public and the dental profession as one made
under the supervision and guarantee of The National Mouth Hygiene
Association.
Leading dentists throughout the coxmtry had requested the Associ-
ation to do this, for the protection of the general public, who are imable
to distinguish between reputable preparations and those containing or-
dinary commercial chalk, injurious disinfectants and antiseptics or other
unsatisfactory ingredients.
The Association did not undertake the actual distribution of Mogene,
however, until careful study had been given to the subject, and investi-
gation showed that it was feasible to produce a dentifrice of the requisite
quality, and to market it successfully.
It is eminently just and fitting that the Association, which has so
much encouraged the use of dentifrices, should derive some support from
their sale, instead of having its philanthropic efforts accrue wholly to the
private profit of established manufacturers of dental preparations.
Nothing imdertaken by the Association, however, will be antagonistic
to the interests of the manufacturers of reputable dental preparations —
on the contrary, the success of The National Mouth Hygiene movement
is greatly to their advantage.
Commercial distribution, of course, implies practical business meth-
ods, and the plans adopted at the meeting on May 29th will, it is felt, put
the distribution of Mogene on a soimd and thoroughly satisfactory basis.
To this end The National Mouth Hygiene Association authorized
its officers to form an organization to be known as the Mogene Labor-
atories Company, which will manufacture Mogene Dental Cream and
also Mogene Tooth Powder under supervision and guaranty of the Asso-
ciation, and distribute them through regular commercial channels by the
most efficient methods of modem merchandising.
In addition, the plan for the distribution of Mogene products provides
as heretofore for cooperative memberships in The National Mouth Hy-
giene Association or its auxiliaries, available on payment of One Dollar
($1.00) by any person interested in promotion of the work. In return he
receives four full packages of Mogene Dental Cream, which is the regular
amount delivered at retail for one dollar.
Digitized by
Google
14 THE DENTAL DIGEST
This Cooperative Package has already shown great earning possibil-
ities to the direct benefit of the local auxiliaries, and should develop tre-
mendously with full realization of the opportunity by all active members.
The Cooperative Package, being distributed at the. full retail price
through the auxiliaries, can be sold at less ''overhead" expense and ap)-
proximately 50 cents out of every dollar can be applied to the funds avail-
able for local work.
It also is of great assistance in soliciting a large Cooperative Member-
ship— and thus enlisting more and more persons in the cause of Mouth
Hygiene — because the recipient gets back the full value of his member-
ship fee in a dentifrice of exceptional merit, and knows that he is at the
same time contributing half the purchase price to philanthropic work.
Another important advantage of this package is that it helps the sale
of Mogene through the regular commercial channels. Those who are
thus once introduced to Mogene almost invariably become enthusiastic
users because of its pleasant flavor, entire freedom from grit or other
injurious ingredients, and its superior cleansing properties.
The sale of Mogene to the great general public will be prosecuted by
the most efficient methods of modern merchandising. Especially in
cities where the local work of the Association is well established.
Mogene Dental Cream and Tooth Powder will be advertised to the
public, and placed on sale at reputable drug stores and department stores.
Each case of one dozen packages will contain a participation certificate
to be held by the dealer until collected by the authorized local representa-
tive of The National Mouth Hygiene Association or the local dental
organization. Return of these certificates to the Executive OflSces of The
National Mouth Hygiene Association will entitle the local auxiliaries
to pro rata participation to such funds as may be set aside for the pur-
pose from the general revenue of the Association.
This participation plan has been carefully worked out and should
prove to be better than the benefit checks formerly used.
In all matters relating to receipt and disbursal of funds, whether from
contributions, sale of Mogene products or any other source, the Associa-
tion has made it impossible for any of its present or future officers to ap-
ply its revenue to any save its recognized philanthropic needs.
It is not only bound by its incorporation as an association not for
profit, but by a definite guaranty — ^which has been widely published and
is printed on the containers of Mogene products — as well as by contracts
with auxiliaries and other local organizations.
To make doubly sure, the Association has appointed a National
Board of Censors composed of the following well-known editors repre-
senting dental and educational journals and the public press:
Digitized by
Google
CONDITIONAL SALE OF DENTAL FIXTURES AND FURNITURE IS
Dr. C. N. Johnson, Chicago, 111., Editor of The Dental Review,
A. E. Winship, Boston, Mass., Editor of The Journal of Education.
Dr. George Wood Clapp, New York City, Editor of The Dental Di-
gest.
Wm. C. Bruce, Milwaukee, Wis., Editor of American School Board
Journal.
Henry C. Williams, Columbus, Ohio, Editor of The Ohio Teacher.
Dr. L. P. Bethel, Columbus, Ohio, Editor of The Dental Summary.
Frank B. Noyes, Washington, D. C, President, Associated Press.
These gentlemen are empowered to examine the books and records
of The National Mouth Hygiene Association and its subsidiary organ-
izations. Should they discover any evidence that the Association is not
carrying out its obligations to the general public and to the dental pro-
fession, it is their duty to give such evidence widest publicity in the
journals which they represent.
The dental profession has every reason to feel confident that the new
plans for the manufacture and sale of Mogene products will be of great
assistance in realizing the high aims and purposes of The National Mouth
Hygiene Association.
In conclusion, I cannot be too emphatic in stating that The National
Mouth Hygiene Association is a corporation not for profit, and will con-
tinue as the avowed servant of the organized Dental Profession and the
American People in the effort to advance their highest interests and de-
serve and secure their unqualified support.
CONDITIONAL SALE OF DENTAL FIXTURES AND
FURNITURE
(New York) Plaintiff claims that he purchased of defendants in April
1904 furniture and fixtures for which he agreed to pay upwards of $900
in payments of $20 per month, and that until the full payment of the
purchase price the title to the furniture was to remain in the defendants;
that up to January, 1907, he had paid thereon the sum of $492. It
appears that in 1904 there was some paper writing executed by the par-
ties; the plaintiff claiming that it embodied the terms of the conditional
sale above specified. The defendants deny that they sold the furniture
to the plaintiff, asserting that they simply leased the same to him, and
that the monthly payment was not to apply on a purchase price, but was
simply rental for the use of the furniture, and that the plaintiff was not
to become owner of the furniture in any event. Plaintiff defaulted in the
payments at this time and defendants made an assignment of the furniture
Digitized by
Google
16 THE DENTAL DIGEST
and fixtures to one Pierce who demanded ix)ssession. The plaintiff
brought this action contending that under section 65 of the Personal
Property Law he was entitled to recover from the defendants all the
moneys he paid to them on the purchase price of the furniture; that the
defendants having retaken the furniture by the assignment of the lease
to Pierce, and not having sold the same by public auction, there is due
plaintiff from the defendants the sum of $492 and interest for six years.
In the trial court judgment was entered for defendants holding the
transaction to be merely a lease. On plaintiff's appeal to the Supreme
Court this decision was reversed, the Court saying:
"Plaintiff's right to recover depends upon two important conditions,
viz: First, that he purchased the furniture and was to have title when he
paid $946; and, second, that the defendants, or their successor in interest,
retook possession thereof under the contract of sale. It was established
that no sale of the furniture was had by public auction as provided by
statute.
"The testimony on the trial will warrant no other conclusion than that
the furniture was to become the property of the plaintiff when he paid the
full purchase price. Treating the moneys paid either as being payments
on the purchase price or as being rent for the use of the furniture, the
transaction must be construed as a conditional sale, if upon full payment
of the amount agreed to be the purchase price title to the furniture was to
vest in the Vendee.'' (Ostrander v. Bricka, 154 N. Y. S. 786.)
DENTAL OFFICE SCENE OF TROUBLE
(Maine) A police officer who entered the reception room of a dentist
on a matter of personal business does not, though he thereafter greatly
disturbed the occupant and refused to leave when ordered, become a
trespasser ab initio, the case being different from that of an officer law-
fully entering upon property in execution of process, or of a guest entering
an inn.
The Supreme Court of Maine so held in Nichols v. Sonia. The facts
were as follows:
The defendant on the 2d day of December, 1914, at Bath, with force
and arms broke and entered the dental office of said Nichols, situated at
No. 81 Front Street, and thereby greatly disturbed plaintiff in the quiet
possession of his office, and then and there remained after he had been
ordered to leave, and vacate the office by the plaintiff. Defendant used
insulting language, threatened violence, and used slanderous words while
he remained in the office.
The evidence disclosed that plaintiff, shortly before half past 10
o'clock in the evening of the day alleged, was in the operating room of
Digitized by
Google
CONDITIONAL SALE OF DENTAL FIXTURES AND FURNITURE 17
the suite of rooms occupied by him as an office; that the rooms were
lighted; that plaintiff was there in the transaction of his business; that at
the hour last named the defendant, a policeman of the city of Bath,
opened in the usual manner the door giving entrance to the suite of plain-
tiff, and entered one of the rooms, the door being latched but not locked.
In this room was the wife of plaintiff. The defendant then made in-
quiries as to the future disposition of a cause in court which had recently
been decided in his favor against plaintiff, and, upon receiving a reply,
indulged in profane language, opprobrious epithets, and charges of per-
jury, declining to leave the apartment when ordered to do so by plaintiff.
Suit was brought charging the defendant with trespass. The lower court
entered a nonsuit and an appeal was taken to the Supreme Court where
the nonsuit was affirmed. The Court in disposing of the case said, "The
contention of the plaintiff that the defendant by his conduct became a
trespasser ab initio^ cannot be entertained. Defendant did not enter in
the discharge of any of his duties as policeman. His entrance was not
by authority of law, as is the case of an officer lawfully entering upon
property in execution of legal process or of a guest entering an inn. The
office was alight, the hour not unreasonable, the place improper, nor the in-
quiry impertinent. His errand was one of business, and we must find upon
the evidence that, if not an invitee, he was in by license of the occupant.
The exceptions to the order of nonsuit must therefore be overruled.
Exceptions overruled. (Nichols v. Sonia, 95 A. 209.)
DENTIST ENGAGED IN SALE OF PROPRIETARY MEDICINES
(New York). The New York Supreme Court in Kilmer v. Dr. Kil-
mer & Company has held that an injunction will be allowed to restrain
a partner in a patent medicine business from receiving and opening any
mail addressed in a manner from which it appeared that the communica-
tion was intended for the other member of the firm personally or pro-
fessionally.
Prior to 1892 Dr. Andral Kilmer a dentist and Jonas M. Kilmer were
engaged as copartners in the manufacture and sale of patent medicines.
In 1892 Andral sold the business to his brother for $40,000. The sale
included all trade marks, copyrights, labels, wrappers, circulars, pam-
phlets, etc. Needless to mention the good will of the business was also
transferred. Andral was to receive 25 per cent, of the profits of the
business.
In 1901, Jonas M. Kilmer sold the business to his son Willis Kilmer
who after engaging in the manufacture of the patent remedies until 1909
sold the business to a corporation. The corix)ration adopted the name of
the Dr. Kilmer Company.
Digitized by
Google
18 THE DENTAL DIGEST
Dr. Andral Kilmer brought this suit against the corporation to en-
join it from using the prefix ''Dr/' or from using his picture and receiving
mail addressed to Dr. Kilmer. His claim was that the corporation
wished the general public to believe that he was still connected with it.
Kilmer asked the court to enjoin the company from receiving and opening
mail addressed to Dr. Kilmer or even to the Dr. Kilmer Company. The
court granted the injunction saying that defendant knew, or ought to
know, that a letter addressed to plaintiff with the prefix ''Doctor" or
with the word ''Personal" on the envelope was for him. The defendant
knew or ought to have known, that when a person writes to any address
containing the name or designation of a professional man that letter con-
tains a private and confidential communication not intended to pass
through hands who have no right to know its contents.
The defendant had the right to manufacture and distribute for sale,
and advertise the same, all of the medicines originated by Dr. S. Andral
Kilmer and transferred to Jonas M. Kilmer; it had a right to designate
them as so originated and compounded by Dr. Kilmer, but it has no right
to so use the plaintiff's name as to lead the public to believe that he was
still responsible, by reason of active supervision, for the contents of a
bottle covered in part by his portrait and name. (Kilmer v. Dr. Kilmer
Co., IS4 N. Y. S. 982.)
WHAT I LIKE ABOUT MY DENTIST
By C. D. B., Plaixfield, N. J.
Thinking that the results might prove interesting to the readers of
The Dental Digest, I recently asked a number of women in my home
town what they liked about their dentists. Their replies I append below
vjrbatim — they speak for themselves.
"He doesn't put his whole fist in my mouth."
"He stops the minute he sees he's hurting me."
"He arranges his appointments so systematically that I don't have to
wait long in the ante-room."
"His waiting room is so cheerful and cosy that I don't mind waiting."
"He doesn't keep you in the chair until you never want to see him or
his office again. He believes in shorter appointments and so do I."
"He's a careful workman, he never blunders."
"He's a good conversationalist. He helps me to forget I'm having
my teeth fixed."
Some of these "reasons why" may seem hardly important but they're
all actual "women's reasons" and perhaps they'll carry just a suggestion
for better service to someone.
Digitized by
Google
(AINE/y^VILDING
''Nothing but the very best of instru^
merits and materials can give your ability
the assistance it deserves."— Se/ec^ed.
THE BUSINESS SmE OF PROPHYLACTIC AND
RESTORATIVE PRACTICE
By W. F. Spies, D.D.S., and George Wood Clapp, D.D.S., New York
FIRST PAPER
If a prophylactic and restorative practice is financially profitable, it en-
ables the dentist to render patients important services and to receive
proper remuneration therefor. If it is not profitable, the dentist will be
unable to apply to such service a high degree of skill, patients will be de-
prived of benefits they should enjoy and the dentist will not receive proper
remuneration for his skill and labor.
Few dental practices are financially successful save as the result of
careful attention to their business side. Some practices make money be-
cause the fees for some kinds of service are higher than is justified by the
costs of those operations, which is unjust to the patients who receive those
particular forms of service. In practices where fees are fixed in this way,
the fees for other forms of seI^dce (such as consultations, treatments, etc.)
are often disproportionately low, which works injustice to the patients
who paid the high fees and to the dentist.
It will be much better for all concerned when fees for the several
forms of dental service can be determined with justice to all patients and
to the dentist, so that no one pays more than he should and the dentist
is always sure of adequate payment for his labors. The object of this
series of articles is to show how each dentist may learn what each form of
service costs him and what are the minimum fees which are fair to his pa-
tients and himself.
We are unable to fix such fees for any individual dentist, but we have
kept such detailed records and have access to such office cost reports from
other dental practices that we are able to state approximately what many
operations cost dentists in practices where the gross receipts vary from
$1,500 to $5 ,000. We offer this information in the belief that this form of
knowledge affords the only intelligent basis for determining minimum
fees, and in the hopes that it may inspire other dentists to develop exact
information concerning their own practices.
Digitized by V:iOOQIC
20 THE DENTAL DIGEST
ESTIMATING OFFICE COSTS
College costs $i,ooo
Three years' time at $500 1,500
$2,500
Reception Room Investment 102
Operating Room Investment 820
Laboratory Investment 130
$3,552
Operating Costs:
Depreciation (10% of first cost of office investment) . $105
Refunding investment (5% annually of total invest-
ment) 175
Rent 334
Heat 12
Light 45
Phone 12
Laundry 26
Assistant (?)
Publicity (cards, tickets, etc.) 10
Express and postage 12
Taxes (?)
Insurance 5
Magazines and books 10
Society expenses 15
Laboratory bills 100
Supplies other than precious metals 160
Precious metals 140
$1,161
Total practice annually $2,500
Fig. I. — Illustration of a chart which has been found useful in determining office costs.
It is here shown as filled in for a well conducted practice with gross receipts of $2,500
annually. This is believed to be about the average size of practice.
Digitized by V:iOOQIC
BUSINESS SIDE OF PROPHYLACTIC AND RESTORATIVE PRACTICE 21
THE ELEMENTS OF COSTS
The cost of any operation to any dentist can be determined only by
learning what it costs him to conduct his office during each income-hour
and then multiplying that cost by the hours or fractions thereof involved
in the operation. If precious metals or teeth were employed, their value
should be added to the product of the hour-cost and the time.
The income-hour cost can be easily determined with approximate ac-
curacy. The items of cost in fitting the dentist for his special vocation,
and of establishing, equipping and conducting the office should be tabu-
lated. The form illustrated in Figure i has been extensively used but may
be modified as desired.
OFFICE HOURS AND INCOME HOURS
The hours which the dentist spends at his office may be conveniently
referred to as office hours. It is believed that under ordinary conditions
these hours should number about 2,000 per year. Dr. W. J. Holroyd sub-
mits the following table showing how the number is determined. This
number of hours permits proper attention to business and to the study and
recreation which are so necessary to mental advancement and physical
health:
365 days
52 Sundays off
313
6 holidays before mentioned
307
28 days' vacation
279
21 days for dental meetings at different parts of the year
258 or 37 weeks per year, less ^ day per week, making
i8i days subtracted
239^^
Multiplied by 8 hours in office
19 1 6* office hours per year
Not all of the office hours can be employed in service for which full
fees can be charged, and some time will be so employed that no fee can
be charged. Time is usually lost in greeting or dismissing patients, in
•Very few dentists can take one half day off every week in the year and 28 days' vacation
and this 19 16 hours will doubtless extend to 2,000 hours.
Digitized by
Google
22 THE DENTAL DIGEST
visits, by friends or business people, in making appointments, in telephone
calls, in charity work, and in other ways, leaving only about 4 hours a
day actual income hours. The income-hours afford the only exact and
satisfactory basis for determining costs and estimating fees.
Experience seems to show that of 2,000 office hours per year not more
than 1,000 will be income-producing hours under even the most favorable
conditions, and in many practices the number will be much less. The
estimates of costs which follow are based on 1,000 income-hours per year
in the belief that this number will not often be exceeded.
CLASSES OF PRACTICE
In order to render our time records valuable to dentists in determining
their own operation-costs it has been necessary to divide practices into
classes to determine the income-hour cost for each class, and then to mul-
tiply our time records by the income-hour costs.
Class I practices of less than $2,000 gross receipts annually.
Class II ptactices of $2,000-2,999 gross receipts annually.
Class III practices of $3,000-3,999 gross receipts annually.
Class IV practices of $4,000-4,999 gross receipts annually.
Class V practices of $5,000-5,999 gross receipts annually.
It will be found easy to remember the classes if it is observed that the
class number is the same as the first figure of the total receipts.
Practices will hereafter be referred to by these numbers.
{This article will be continued next month)
HOW TO MAKE AND SAVE A COMPETENCY FOR OLD AGE
I see in your November number, an article entitled '^ A Compensation
For Old Age," that has induced me to write these lines, not to find fault
nor to criticize, for in the main I agree with the writer, and as I have been
a practitioner of dentistry for over thirty years, I think I can tell the
beginner a lot.
This is an age that realizes the power of Corporation or Cooperation,
and to succeed in our profession to the extent of gaining a competency
these principles have to be applied — so let us get to work and form a cor-
poration of the following Stock Holders: —
ist. Mr, Talent. He is hard to describe, but most anyone can tell
him after seeing him design and execute some appliance, he is the first
and most essential party and do not attempt to run business without him.
2nd. Mr. Like. This does not mean that you have to be dead in
love with every detail of the profession, but it does mean that you are to
Digitized by V:iOOQIC
HOW TO MAKB AND SAVE A COMPETENCY FOR OLD AGE 23
look upon it with pride and as a choice and not as a compulsion. It
means that you are to enjoy seeing things work, and that you really feel
as though you are doing something worth while. Remember that there
is no business that does not have its objectionable feature.
3rd. Mr. Qualify. Be certain that his name is what he says and
that he keeps, day by day, busy, to keep up with the times and if he
changes his name, see that it be to Qualifying^ that means continually
at it.
4th. Mr, Slick. That means keep at it. Yes, everlastingly at it,
(but this does not mean that you are to take no rest). The public like
to patronize a busy man — ^be occupied whether you are or not, profes-
sionally, you see?
Sth. Mr. Equip. Supply yourself with a good outfit, especially
instruments and keep a sharp lookout for the new things that come
along but be careful not to invest in everything advertised and in noth-
ing until you are confident it will prove what you want.
Do not throw away your old instruments entirely to use the new, but
get such of the new as you can use and appear well. I have some of
Frank Arnold's make of instruments, especially forceps, that I have had
from the beginning and they are not plated (as that was before the day of
plating everything), but for service, for real adaptableness, there has never
been better made. While I have scores of other forceps, I frequently
in difficult cases reach for the Old that I kno^ are tried and true — instru-
ments are like friends. It is well enough to make new friends and try
them, but do not throw off the old tried and true ones, because they are
not nickel-plated.
6th. Mr. Fee. Charge reasonable but compensating fees and make
no apologies for so doing.
7th. Mr. Appearance. Keep your office as well as yourself and in-
struments, sanitary, clean, attractive, but keep an eye on the expendi-
tures for same.
Sth. Mr. Relaxation. Take time for recreation and especially the
one day in the week, the Sabbath — God knew what was best for man
physically as well as spiritually, and he says "Rest on the Sabbath."
I have tried it and I know that it is true. Every few years take a week or
ten days off and go back to the college from which you were graduated —
visit the old members of your class if they are on your way, and note how
they are getting on and you will find that you will learn and be improved
by seeing how some have succeeded better than you, and you will feel a
sense of pride and encouragement in seeing how much better you have
done than some others.
If you live in a country town, go to the city for a vacation, now and
Digitized by
Google
24 THE DENTAL DIGEST
then, and keep your eyes and ears open to all that is to be seen and
heard. When you get there, get a good nice clean, respectable place to
stay; this does not mean that you are to go to the swellest hotel there and
fill your stomach full of things that you are not used to eating, and make
not only a hog of yourself but a fool as well. Leave off drinks and dopes.
If you are located in the city go to the country for this vacation.
Go to the mountains where Him, Bob, Mam, Sal and Beta live and see
how they spend life. Get a good mountain breeze, and listen to the
trickling streams. Do not fail to take your fishing tackle along, there is
nothing that will thrill you like the bite of a trout or black bass. I went
out the other day and strung up fifteen black bass (beauties they were).
My boy about eleven years old went with me and he caught two and
got quite a number of strikes that he failed to land and the other night
he said to me "Father, I can just feel those fish biting yet, can you?''
Yes, and hope to all winter. Try it, but do not spend too much time.
9th. Mr. Economy, Be economical and I do not mean by that to
be stingy and stint yourself and family, but keep well within your means
— have good, well cooked, wholesome food for yourself and family, for it
is more economical, to say the least, than doctor's bills and drug expenses.
Wear, and let your family wear good, neat, clean clothes, but in all things
be not a spendthrift for this will not only take your money but teach your
family bad habits.
Do not try to keep up with the fellow who has inherited a lot of money
and has nothing to do but fool it away. It is well enough to have him
as a patient, but not as a chum.
Refrain from useless, hurtful and expensive habits, among which are
drinking, doping and the use of tobacco. I will specially mention only
the last named, (but many others bear a similar solution) the use of to-
bacco does not help your appearance, but quite the reverse. It does not
help your physical condition, but in many if not in all instances, it is
hurtful. The pleasure, if any, is more than offset by the displeasure in not
being able to indulge many times. How about the expense of it? I be-
gan the use of tobacco by the advice of a physician, about the time I did
dentistry, and after using it a while I took an inventory of myself on that
line and I soon saw that it did me no good, but harm. It did not make
me look any better, nor did it make me smell any better either.
In that inventory I figured that at the present rate, (about 7 cigars a
day) it would, within thirty years cost me enough to buy a nice home.
I quit and to-day I am living, fully paid for, in a nice home saved in
this way, (just make the calculation and it will amaze you) and I ex-
pected also to have some boys and I did not want to set them that kind
of an example and so you see that I will not only be benefited, but future
Digitized by
Google
HOW TO MAKE AND SAVE A COMPETENCY FOR OLD AGE 25
generations also. If you are already a user of it, you will say *' that you
can not quit it," and I agree with you that it is hard to do, but the only
way is to quit and stay quit — yes quit, and in twenty years or less you will
have saved for yourself and family, a nice home, and just think, too, of
the offensive odor of tobacco you have saved your patients from inhaling.
loth. Mr. Literature. You should keep some good literature in
your office for your waiting patients and be certain to read up yourself
on all current events. A good daily paper and at least two good weekly
periodicals should be read and at handball JSe-Jti^e/-^ j. ;*
nth. Mr. Congenial.. Ypu sliQulclJefirn n©t.6nly how to handle pa-
tients while in the ch^fr^ but how-to iiieci ihtem^rjdce^p^ci^lly-hqw to dis-
miss them; all this requires kjiackltud,sjtiidy of human nature as you can
not do with all just alike. ' : »' :»: : /A - •. ^- ,;
1 2th. Mr. Personality. You should be yourself and not imitative
nor affected. Do not expect to please everybody for Christ did not do
that but stand for your rights and principles on all lines and be able to
give reason for the faith within you.
13th. Mr. Financier or Mr. Investor. Now, I hope you are not
superstitious about the number thirteen and if you are you may add
other Stock Holders, but see that you have at least these named. Do
not expect this last named party to be so perfect as to make no mistakes
for he will make them by doing things he ought not do and worse, by not
doing things he should do, but do not attempt nor expect to succeed so as
to reach the point set out without this last named partner.
I look all around me and I see monuments to my folly by doing the
wrong thing as well as for not doing the right thing.
Remember that there is but one kind of a man that makes no mis-
takes and that is A dead man.
This Stock Holder is hard to describe because times, conditions and
places vary so much. A very great deal depends upon how you invest
your money, because years of earnings can be swept from you in the
twinkling of an eye. No one can tell you how to do this for as above said,
times, condition and places are not all alike. But for the past twenty
years investments in real estate have been the safest and best in all sec-
tions of the country, and is getting better in many sections and especially
in the South. Good farming, grazing and timber lands have been and
always will be the best on this line. Shy at mortar and brick or tenant
property, as they are too much trouble and expense to look after. Run
from Boom Town property, do not listen to the Boom promoter when he
tells you that such and such a lot, now covered with brush and sedge
grass, will eventually bring thousands of dollars, for I tell you from
personal experience that most of them will not bring the taxes, eventually.
Digitized by
Google
26 THE DENTAL DIGEST
Fear Mining Stock as you would satan and in fact all kinds of stock for
several reasons! One is, that they contain too much water and what is
not water, is wind. Remember the earth's surface is about three fourths
water and too plentiful to pay such a high price for it.
Loans on lands secured by deeds of trust have always been good and
always will be if made on good titles and not over half the selling price on
forced sales. This will yield 6 per cent, and good as gold. I could loan
thousands aud.tj^ousand&atd^llaj's thus secured.
Many thi^^-'^ojHeJ fe said abbut financiering, but time and space arc
. ...HQt.sii^iant.her^.:^.: "; : .-. -/i
V I :JSi>.^sU5ilb'iJisfe- Stock Hoid:^!-
dfefs-'Wofk fo^gether continuously and har-
monio,u§ly,j^oiii augKj to hne ^le:tctlay ty^'a;competency in tangible prop-
ert^yJfo.-yleltEyou-'a.dufiiacnt'incoSYic 16 s\jtpp\y your needs, say $30,000
and that even 4 per cent, will yield you $1,200 a year or $100 a month.
Be not discouraged if you have set your competency at $30,000 in 30
years if the first years do not yield the thirtieth of this or $1,000 for the
first $1,000 is the hardest to get and remember that what you save should
be put to work to help make a part of the next $1 ,000 and so you will
see that when you have saved $1,000 and put it to work that it pays $50
a year on the next at 5 per cent, interest and so on.
The above results can be reached as I can testify from experience, but
I want to say that it takes **get up'' and "hustle," yes and plenty of it,
for this is no small matter, it is a man's job, to reach this point and to de-
fray the heavy expense of keeping and educating a family. It takes a
head and back-bone and everlastingly sticking to it — you will have to
pay the price.
I might speak further about a Competency in Old Age in the way of
Boys, as I have four of them. It is a very poor boy, when well cared for
and educated, that is not worth $30,000 to his parents or that could not
nor would not take care of faithful parents in old age, so if mine pan out
all right they will be worth $120,000 on a cash basis to say nothing on
other lines.
The above is rather long, but it is not imaginary nor speculative, but
knowledge from actual experience.
Now, you imagine that I am an old wornout man, but you are er •
tirely mistaken, for I h^.ve laid up a Competency in strength and youth-
fulness by observing the Laws of Nature and stouter to-day than when 25
years of age. Lay up a competency in strength and youthfulness by
right living and not by idleness and laziness. Very few kill themselves
by work, but multiplied thousands do by dissipation, anc they say, I am
working myself to death.
N. W. D.
Digitized by
Google
HOW CAN HB BETTER CONDITIONS? 27
HOW CAN HE BETTER CONDITIONS?
Editor Dental Digest:
I take the liberty of writing you about a subject that is of vital im-
portance to me, and which gives me no little trouble.
The dental fees in our little city are the lowest in the state, and if you
will pardon me for going into details which are excusable when writing
about a subject of this kind, I will explain the situation as follows:
H is a town of about 7,000 population and is surrounded by a fine
back country. There are three dentists here including myself. Dr.
A has been here in active practice for thirty years, and Dr. B. for
about 18 years. Dr. A. is about 50 years old and related to a number of
people in the country. He had the fees down so low that a man can
hardly make a decent living, unless he is a very fast operator and has a
wonderful constitution; all of these this man possesses. Our fees are
as follows:
Cleaning teeth $ .50
Amalgams 50
Gold fillings i . 00 up to $2 . cxj and then a gold crown
Gold crowns 2.50 to $4.00
Vulcanite dentures 8.00 to 10.00
Filling with Amalgan and treatment 1.00
Porcelain crown 2.00
Extraction 25
And all other operations accordingly.
I have been here for nine years, and during that time I have tried to
get Dr. A. to raise the fees, and he says that the people will not pay them.
He gives very long credit and does not try to collect, and this is a great
drawback to one who wants to run this part of the business in a better
way. Dr. B. I think, would be willing to raise the fees if A would agree,
but we have to hold back on account of the latter. This old fellow has
the most wonderful grip on the people that I ever saw, and they will be-
lieve anything he says. He guarantees all his work, and no matter how
long it has held good, he will put it back free of charge. Until three
years ago he did excellent work, considering his immense patronage. He
works from six a. m. to eight p. m., and his long hours without rest, are tell-
ing on him. He is growing very nervous and suffers with terrible head-
aches in the summer, which causes him to be more irritable, to the loss
of a patient now and then.
If he had to sweat over making a bridge a few times, he would charge
more for his work. He takes an impression of the abutments, and when
the bridge comes he grinds the teeth to fit the bridge. He keeps single
Digitized by
Google.
28 THB DENTAL DIGEST
gold crowns in stock and has all his plate-work done. This way allows
him to work all the time at the chair at small fees, and being such a fast op-
erator, his cheap fees will amount to something. And up to two years ago
he worked all day Sunday; but now 'tis only half that day that he takes.
I have written in detail about the above man to give you an insight
into his methods. I have come to the conclusion that only death will
remedy things, and if it ever does bring relief it will bring it here. This
man's way of doing is the talk of the fraternity of this state, and if you
have ever seen a constitution of steel, this man has it.
I have read of the successful sanitary dental office, but it is not worth
three cents here where people would wade through filth to get cheap
work. I have read of the man who was complaining all the time when
he should work that much faster. But what is there in all this, if, after
the day is done, you have nothing for your labors, save a tired body and
are sick at heart. There is plenty of work for us three, but nothing in it.
Now Doctor, if you will pardon a few remarks as to myself, that you
may be more ably informed as to the situation here, I will give them. I
worked my way through one of the first colleges in this state, that I might
prepare myself to more intelligently practise dentistry. I have been in
this noble profession long enough to peep over the starvation i>eriod —
nine years. You know where fees are good, and a young man is not
getting much to do, they will bridge him over; but when they are low it
takes many operations to make something. I have sufficient confidence
in myself, not to overvalue my ability, for none of us ever get to that
stage where we cannot learn something. I can say that I am a dentist
who does good work, keeps abreast with the modem methods, a member
of the dental society, and a slow operator, but thorough.
I hope you will pardon me for taking so much of your valuable time;
but if you ever did go into Macedonia to help a fellow, I need your
assistance to see if you can tell me the best way to better conditions here.
E. S. G.
AVOID APPETIZERS
One group of students had a good dinner without alcoholics, a
couple of hours later, digestion was found well advanced; another
group, the same dinner, preceded by a cocktail, digestive processes im-
perfect, owing to the presence of alcohol.
Serious and permanent interference with digestion was proved by
these experiments. The appetizer, so called, is in reality a devitalizer,
destructive of normal processes of the digestive apparatus and of the
mental powers in direct proportion to the frequency with which it is
taken. — Experiments at Yale,
Digitized by
Google
A REPLY TO M. F. R. 29
A REPLY TO M. F. R.
By H. K.
In responding to the request of M. F. R. in the November Digest,
that an ethical man reply to his article, I would say that I believe I have
at least one qualification for the task: — Namely, that for twenty years
I have remained an ethical man, in spite of the fact that I have a very
small practice, along with the responsibilities of a family. Of course,
advertising holds no temptation to a man of large practice.
I believe that a brief answer will meet the case of all those who, like
M. F. R., so freely use the pages of the Digest to advocate disregard of
the dental code of ethics. All dentists are in honor bound to play the
game according to the rules. Let the advertising men and the quacks
take a leaf out of the sportsman's book. All of them know what happens
to the football player who violates the rules, or to the prize-fighter who
fouls an opponent. Even in so crooked a game as gambling the unfair
player is ostracized, simply because he will not abide by the rules of the
game.
None of us was born a dentist. We entered the profession by delib-
erate choice, and so entering found certain rules in vogue, which are
known as the dental code of ethics. Such rules constitute an integral
part of the profession. In this respect dentistry is not peculiar, for every
calling, from law and medicine down to hod-carrying, has its code. True,
in every calling men are to be found who will not follow the code, which
has given use to such terms as '* shyster/' '* quack'' and ''scab." The
unfair man must pay the price.
Every calling contains men who are devoid of the ethical sense, and
to preach ethics to them is to cast pearls before swine. If life holds no
higher ambition than the making of money, then the advertiser and the
quack are fully justified. But some men are so constituted that they
care more for the respect of their fellows (and their own self-respect) than
for money, and would choose to remain poor, rather than degrade a
profession, and incidentally degrade themselves. If a man can do noth-
ing to elevate this calling, he should at least .leave it no worse off than he
found it. Common honesty demands that much. He was not taught
his profession in order that he might mangle it.
I am aware that advertising and quackery present the unethical man
only in his grossest form, and that back of him stands his sly brethren,
who are forever given to the detraction of their competitors. The latter
perhaps, are the worst ''scabs" of all.
Owing to its comparative newness and the grade of men who have
Digitized by
Google
30 THB DENTAL DIGEST
been allowed to matriculate in dental colleges, dentistry contains a far
larger proportion of unethical men than law or medicine; but, notwith-
standing the financial success that appears to attend the imethical men,
signs are not wanting that their days are numbered. The requirements
of the profession are continually calling for men of higher caliber, and
ere long the colleges will consult their own interest as well as the interest
of the profession and the public, by weeding out men who lack compre-
hension of those finer elements that characterize the truly professional
man. Until that day, "virtue is its own reward."
Answer no. 2 to M. F. R.
Editor Dental Digest:—
"Can you answer this man," was the heading on a communication
by M. F. R. I do not know what M. F. R. stands for, but my little
daughter suggested "Money for Rot."
It is deplorable to learn that a man whom I suppose has a dental
college education, can indulge in money-making as described in your last
issue.
I think the most of the men who read the Digest will put aside the
article with a sigh as I do when I glance at our local Sunday newspaper
supplements with heading such as this — "Have rats souls?" and then a
half life size picture of the particular "nutty" professor who produced the
essay.
M. F. R. says that his shrewd business man got business on the square,
but what about the "secret" local anesthetic? I have my opinion of M.
F. R. who feels neglected because the Dental Society to which he perhaps
paid a dollar or two did not help him out in dull times. I hope M. F. R.
will rest from future contributions about his wrinkles, for about two years
exploit in his home city and then report on the permanency of his ad-
venture.
N. J., Minneapolis.
Abscess Lancet: — For an ideal abscess lancet, take a new Duplex
Safety Razor blade, divide at opening in centre. Make point on one
end; on other make shank to fit cane socket handle; cement in place.
Then you have a lancet that will cut without tearing. The lips of
wound will have tendency to flare open instead of closing up.
C, I. Faison, D.D.S.
Dallas, Tex.
Digitized by
Google
MY WAY OF FIGURING THB COST OF AN INLAY 31
MY WAY OF FIGURING THE COST OF AN INLAY
By C. A. G., Grand Rapids, Mich.
For many years I managed my ofl&ce in a haphazard way, but one
fortunate day I ran across the first edition of ** Brother Bill's Letters/'
After beginning the book, I did not drop it until it was finished and, I can
assure you, it was a "hip, hip, hurrah! " for Brother Bill.
My first move toward a better method of managing my ofl&ce was to
raise my prices for dental services to those received by first class dentists
in our dty . With fear and trembling and much doubt as to results I made
the experiment of higher prices on my first new patient. The result was
so satisfactory that from that time on I became braver and the higher
prices were soon a fixed habit.
It is my opinion that the only safe plan for the average dentist to fol-
low is to place his prices on a par with those of the leading dentists of his
conununity. Should he be more than an average dentist, a sort of a wiz-
ard in fact, he may be able to hold his prices above the leading men of
the profession, but not otherwise.
My next and most important move was to make a complete refurnish-
ing of my office, for as the clientele who were to pay the advanced prices
must come from a wealthier class of people they would demand an up-to-
date equipment, as well as first class dental services.
Various plans were adopted by me from time to time for putting my
business on a permanent financial basis. But all of these were finally
abatidoned for one which I have termed the salary plan; the adoption of
which I would recommend to all dentists whether young or old. This
plan briefly stated, was to put myself on a weekly salary, to which I ad-
hered as strictly as though I had been in the employ of some other den-
tist. At first I decided to estimate this salary by the amounts which my
compeers were receiving and those whom I knew best at that time were
making from twenty-five to forty dollars per week. I took the highest
amount, forty dollars, and every Saturday night took home to wifey an
envelope containing a forty dollar check. This check was to take care
of all expenses incurred outside of the office.
In a few months I was able to raise my salary to fifty dollars per
week and now for a year I have been drawing seventy-five dollars per
week. It is my ambition to raise this salary to one hundred dollars per
week after January first, 1916.
To draw this salary I found it necessary to raise prices from time to
time and to adopt ethical methods of advertising, which is another story.
Digitized by
Google
32
THE DENTAL DIGEST
Enthusiasm and the art of salesmanship also entered into these successful
conditions.
The second requisite in adopting the salary plan was to decide as to
the number of hours per day and the number of days per month to be
spent at work. After careful consideration seven hours a day and twenty
days a month seemed the average time consumed.
The overhead expenses of a dental office vary so largely in different
cases that it is difficult to put a fixed price on this matter. In my own
case, after figuring rent, investments in equipment and other incidental
expenses with ten per cent, depreciation of same, I found it cost me
;:AU-^ii
"Every Saturday night I took home to wifey an envelope containing a forty-dollar check"
approximately one dollar an hour, for seven hours a day, for twenty days
a month. With my salary of seventy-five dollars per week, which figures
two dollars an hour for the same number of hours and days, I found that
I must average twenty-one dollars per day, or four hundred and forty
dollars per month. I am able to do this by making a charge of six dollars
for the inlay mentioned and a proportionate charge for all other time
spent by myself at the chair. My assistant does all casting, finishing,
etc., giving me all my time at the chair which would average four hours,
a day of hard, nervous work. With these figures it will be seen that I
have plenty of time for tennis, fishing and traveling in the summer and
hand ball for exercise in the winter, all of which keep me in fine condition
physically and mentally.
Digitized by
Google
'^o
iiirninmiiiit«iuNutii(iHiuitiiiiiiNiimiiiiHiiMi^
ii
.^, BROTHER BILES .
"'" LETTERS Ij
lUiiiuiiiintiU'luioiuuiuijniuiiHiiitiiiiuvBuuiniiiliiiifiiiiiiNHiiiMrtHRiKiiiivniMM
My Dear Jim:—
I note your resentment of my statement that your low fees have
wrought injustice to yourself and your patients. You admit that your
fees are low and that you wish they were higher, but you say that as long
as they are what they are, you are happy in the thought that they have
done a great deal of "good."
I've discovered, since reading your letter, that you and I have very
different meanings for the word *'good." Of course I don't know exactly
what you mean by **good'' but from your letter I think you mean that
because of your low fees your patients are better off than they would be
if you had charged them remunerative fees.
First, however, I want to give you my idea of doing **good'' to paying
patients. It is to render them the highest form of service I can, to teach
them its worth and to charge fees that will make them respect my work
and me.
Now your idea of "good'' seems to be in terms of money. Of course
you don't define it so out loud, or perhaps even in your own thoughts^
but if I read your letter correctly you try to be happy in the thought that
your low fees have saved your patients money. The fifty cents or five
dollars you let them carry away in their pockets is the expression of your
idea of doing them "good."
Your idea might impress me more if I didn't know the town, but
you must remember that I grew up there and that I know about the
financial condition of all the prominent people except those who have
come in since my day. I'm going to use this knowledge to see if I can't
prove your idea of "good" is wrong.
When I visited you awhile ago, I watched several of your operations
for old friends of mine, and I am sure you did not do them "good" in any
form. Take Harry Herter for example, who owns half the bank and half
a dozen other things about town. He came in to have you clean his
teeth, as he does every month. You spent half an hour on his teeth and
charged him a dollar. I didn't run an instrument up under the bifurca-
Digitized by
Google
34 TH£ DENTAL DIGEST
tion of the upper first molars, where the gum has receded, but I no-
ticed you didn't give him anything like the amount and kind of service I
think his mouth needs, and would be much better for receiving. Also,
you should have charged him $1.75 for the half hour you gave him, and
then you wouldn't have needed to go down to the office and work that
evening to make up the loss. It would have been much better for Harry,
in teeth, if you had put in two hours and charged him $7.
Perhaps you think saving Harry the spending of the 75 cents you
didn't charge him, was doing him "good.'* YouVe known and serv^ed
"If you can make Harry put down his cigar long enough to hold a mirror and let you show
him what recession in his gums promises"
Harry for a long time, and some day when you are going by the bank,
you might go in and say "Harry, I feel that I should like to do you some
good; here is 75 cents." I've known Harry and his picturesque profanity
since we were boys, but if you can imagine what he would say, you can
do better than I. Yet that would be better than the basis on which you
are serving him.
I'll tell you what will happen when some bright young dentist who
understands the proper basis for doing "good" comes to town. He'll
serve and educate his patients so well that they'll look up to him and
brag about him. And some day Harry will go in there to get his teeth
"cleaned " and will get a new experience in service and will pay $5 or more
for it, and will say to him just as I've heard patients say many times.
Digitized by
Google
BROTHER BILL'S LETTERS 3^
"Doctor, I wish someone had done this for me years ago/' and go out
thinking about the service rather than about the fee.
Take Mrs. Hutchins as another example. You put a mesioocclusal
inlay in her lower right first molar and seemed quite pleased when you got
$7 for it. You got all the inlay was worth because it will not do a number
of very important things it should. As your practice brings in $3,500
per year, that inlay cost you about $8.40. The occlusal surface was
practically flat. It wasn't formed to hold the opposing tooth in position,
or to articulate with it, or to divert the food from the contact point into
the embrasures and so preserve the papilla. The inlay seemed to fit the
margins well enough, but the upper molar slides just a little when it oc-
cludes on the inlay. In a little while that upper molar will move to where
it doesn't have to slide, and that will be out of proper alignment. I know
because I've made the same mistake. Food will crowd between the
contact point and the adjoining tooth because the inlay isn't shaped to
divert it, and a "meat-hole" will result.
Now if you had spent 30 minutes more on the occlusal surface of that
inlay, if you had mounted your counterdie and opposing model so that
you could have moved them laterally and "chewed out the articulation"
and then shaped the surface to divert food away from the contact point,
and charged Mrs. Hutchins the $11 you would have been entitled to at
your costs, you would have preserved that tooth indefinitely, instead of
insuring trouble in a few years as you have now. I don't think you did
Mrs. Hutchins "good." I think, as the boys say, you "did her up good
and brown," because she's going to lose that tooth 10 years before she
should, and the money you charged for the work. And that will discredit
dentistry and you in her eyes.
If you want to save the Hutchins family money, try the plan I sug-
gested for Harry Herter. Mr. Hutchins isn't rich, but he is about 100
times better off than you are, and is a self-respecting merchant. You try
saving them money at the expense of service they need and let them find it
out, and see how long you will continue to serve them. They know where
true economy lies and they are too shrewd to always be fooled about it.
Of course I know people in the town to whom every dollar is precious.
There are old Mr. Day and the Allen sisters and half a dozen others whom
you serve, who haven't a cent to spare, but who are as fine people as any
in town. They aren't poor people; they're just short of worldly goods.
You can do fliese people real "good" by rendering them a good quality
of service at low fees and you ought to be in a financial position where it
would be a pleasure to you, a little "sweetening," so to speak, of your
daily labors.
The trouble is you have mixed your people all up. Because you can
Digitized by
Google
36
TH£ DENTAL DIGEST
do these people good by serving them at low fees, you have transferred
that idea to everybody. You treat them all alike. That has been a
failure for most of your patients and for yourself and your family.
People like Harry Herter and Mrs. Hutchins have spent their lives
trying to get value for their money. In all things concerning which they
have been educated, they know where true economy lies, and they are
willing to spend $io now to save $25 in five years if you can show them
the saving. If you can make Harry put down his cigar long enough to
"Compare the prices paid for toys this Christmas with the prices our parents paid for
toys for us"
hold a mirror and let you show him just what recession in his gums prom-
ises for the future, and then explain what you can do by keeping every
surface polished and free from irritation, and then that it will take long
enough to cost him $5 a treatment, he will say **go to it. Doc, go to it.''
You would then address yourself to the form of appreciation he under-
stands, present expense but final economy. And you could feel happy
in doing it because you will preserve his teeth much longer than you will
with the present treatment.
If you had explained to Mrs. Hutchins what the present form of inlay
at $7 will do to her mouth in from 2 to 3 years, and what the other form
of inlay might be expected to do, she would probably have thought a mo-
ment and said ** Doctor are you quite sure it will be worth the difference? ''
and if you replied, ** Quite sure," she would have said, *^It seems a little
Digitized by
Google
BROTHER BILL'S LETTERS 37
high, but I want to save my teeth, and you may do as you suggest."
And when she went out with that inlay, you could have been happy in
the thought that it would serve her indefinitely.
With proper fees from Harry and Mrs. Hutchins and a hundred
others, you would be in a financial position to serve old Mr. Day and the
Allen sisters and a few others at purely nominal fees.
I contend that your idea of doing "good" is wrong, that you do not
good but evil to all concerned. It is time to wake up, to take your eyes
for a moment from teeth and look at people. Observe them in the stores.
Compare the prices they have paid for toys this Christmas with the
prices our parents paid for toys for us. Note whether the shoddy toys at
low prices are bought by even those people who are in moderate circum-
stances. Ask Mr. Hutchins to tell you: He knows. When I compli-
mented the appearance of his store, he told me that he now has to carry a
much better line of goods than formerly or lose his business. Said he "I
now sell thousands of dollars' worth of goods that I never thought this
community would buy on account of the high first cost."
Get your service on a modern basis. Do "good" in teeth to people
who have money, and in both teeth and money to those who are short on
worldly goods.
"NOW BLOW— BLOW HARD"
In the rear of the nose just above the soft palate are the opening
of the eustachian tubes leading to the middle ear. Hard blowing of
the nose may force colonies of bacteria through one of these tubes into
the middle ear, producing inflammation with resulting ear ache.
If not at once checked by opening the ear drum and disinfecting
the ear, deafness may result, or the inflammation may extend into the
spongy bone of the mastoid process. In the latter case, it is probable
that a hole will need to be chiseled through the outer layer of the skull,
the diseased bone excavated, and the cavity sterilized, or death may
ensue. Many a mother has caused the death of her offspring by put-
ting a handkerchief to his nose and saying, "Now blow. Blow hard!"
Mastoid abscesses are serious afflictions, and by no means uncommon.
One of my friends averages more than one mastoid operation a day
through the year. Dr. Wm. L. Hooper, Tufts College. — Healthy Home.
Digitized by V:iOOQIC
RAGTiOL Hints
[This department is in charge of Dr.
V. C. Smedley, 604 California Bldg.,
Denver, Colo. To avoid unnecessary de-
lay, Hints, Questions, and Answers should
be sent direct to him.]*
A Method of Applying Arsenical Paste. — A safe way to apply
arsenical paste in a cavity is to take an automatic amalgam carrier, place
a small piece of cotton in barrel and place the arsenical paste on the
cotton; it can then be applied without fear of falling on the mucous
membrane. — George E. Cox, D.D.S., Wilmington, Del.
1. Three Hints That I Find Practical. — ^Buy a one quart Thermos
bottle and have warm water at your chair for three days with one heating.
2. In large canals when pulp is difficult to remove, place two small
broaches in holder at once and remove the pulp first time.
3. In using arsenic in deep interproximal cavities always have a
piece of temporary stopping tight against gingival margin, then apply
treatment and cement. This forces away any overhanging tissue from
cavity and does away entirely with dangers of arsenical poisoning. —
A. C. Sloan, D.D.S., Baldwin, Wis.
To Keep Water Sterile for Hypodermic Work. — Sterile water
for hypodermic work can be kept clean by using the glass dome of the
'^Nontoxo Sterilizer" to cover a ground glass stoppered bottle of four
or six ounces, bottle to be used on a clean glass slab. Makes a fairly
good joint to keep out **bugs.'' — M. V. Baker, D.D.S., Marysville,
Wash.
To Compensate for Shrinkage in a Large Gold Inlay. — Where
a cast gold inlay is to be made for a cavity involving the mesial, occlusal
and distal surfaces of a bicuspid or molar, if there is any shrinkage the
inlay will invariably show a defective line at the gingival margins. To
overcome this, the gingival margins of the cavity should be quite freely
beveled so that the inlay will cover them with a lap joint instead of a
butt joint. Even if there is a slight shrinkage the thin lap of gold can be
burnished down to the cavity margin so that when cemented the inlay
will perfectly seal the cavity. — I. D., The Denial Review.
*In order to make this department as live, entertaining and helpful as possible, questions
and answers, as well as hints of a practical nature, are solicited.
Digitized by
Google
PRACTICAL HINTS 39
To Prevent Thumb-Sucking in Children. — Dr. Geo. H. Hen-
derson calls attention to a very ingenious method of preventing thumb-
sucking suggested to him by Dr. Truman W. Brophy. Make a paste-
board cuff of the right size and length to slip on the arm, small enough
not to slip off the hand. Sew cotton or other material on the edge to
prevent it from irritating the hand. It can be boimd with adhesive tape
or straps and buckles. This will prevent any use of the elbow, and it is
much more humane than the use of bitter drugs and other such expedi-
ents.— The Dental Review,
Method of Separating and Regaining Space Where Teeth
HAVE Been Lost for Sometime. — Cases are often presented to us
where it is desirable to reclaim the use of a root that has lost its crown.
However, upon examination, we find that the crowns of the teeth ad-
joining the space have drifted out of normal contact with their neighbors
to a point where it is not possible to place a crown of sufficient width and
size. This condition may be obviated by using an old but effective
method which is as follows: Place the end of an elm stick in a vise and
compress imtil it can be slipped into the space to be separated, and sawed
off short enough to avoid interfering with the articulation. In cases
where a very short root is to be reclaimed, a piece of softened gutta
percha may be placed over the root end to force the gum tissue away and
the wedge inserted over it. Sufficient expansion of the wood will take
place as soon as the saliva comes in contact with it, to produce a gradual
and quite comfortable separation which will continue for several hours.
It is well not to force this wedge in too tightly, since a too rapid separa-
tion will result with much discomfort to the patient. In most cases one
wedge worn from twenty-four to forty-eight hours will provide the de-
sired space, while in some cases two wedges may be necessary.
This method not only has the effect of producing a separation but has
a far more important one, i.e., forcing the drifted adjoining teeth back
into firm contact and tilting their occluding surfaces into correct align-
ment and articulation, thereby eliminating one of the fertile causes of
pyorrhea pockets. There need *be no fear of Fosing the space obtained,
while the crown is being made and adapted, since the wedge may be
removed and replaced as often as necessary. Hickory was formerly
recommended for making these compressed wedges, but I have found that
ielm is better since it is a soft wood that will admit of considerable com-
pression without splitting, and will take up moisture more rapidly. —
Lewis G. Watkins, D.D.S., Detroit, Mich.
A Time-Saving Hint. — ^When treating, and in some cases, when
filling, an upper tooth, excepting the second and third molars, a cloth
Digitized by
Google
40 TH£ DENTAL DIGEST
napkin can be secured with a clamp to a tooth distally located from the
one to be operated upon, and by placing a cotton roll under the lip or
cheek, as the case may be, all moisture is excluded from the field of
operation for a sufficient length of time to enable you to render the service
required. This method can be adopted in most cases, but of course some
cases cannot be managed in this way, requiring the rubber dam. Anyone
making use of the napkin as indicated above will save much valuable
time, and cause less discomfort to the patient. — H. A. Cross, D.D.S.,
Chicago, 111. — The Denial Review.
Extracting a Post from a Frail Root. — In ?xtractmg a post from
a frail root with a post puller there is always danger of splitting the root.
The likelihood of this happening may be reduced to the minimum by
taking a piece of twenty-eight-gauge German silver plate, cut a hole
through it large enough to pass over the post and trim into a disk about
the size of the root face. This disk may then be placed on the root with
post projecting through its centre. The post puller may then be placed
in position and as it is tightened the part of the instrument which is
intended to bear on the root rests against the metal disk and does not
slip or spread and the post may be drawn with safety. If the face of the
root is uneven from decay, a bit of base-plate gutta percha may be
molded into the cavity, the disk pressed into place and chilled with cold
water, giving an even base for the instrument to press against. — ^J. A.
Bullard, D.D.S., Chicago, lU.—The Denial Review.
Water and Teeth. — As a general rule, water with high total solid
residue, including a large amount of calcium salts, is not favorable to the
health. The soundness of the teeth, however, is in direct proportion to
the degree of hardness of the water used in the locality in question. The
finest dentition was found in districts where the water contained mag-
nesium as well as calcium salts. The former are stated to harden the
enamel. — Rose, Giorn. farm. Chim.; Ghent, Abslr. {British Journal of
Denial Science.)
Rendering Cork Stoppers Impermeable.— In order to render cork
stoppers impermeable to alcohol and acids, they are dipped in a cold
solution of rubber in chloroform, and allowed to dry in the air until the
chloroform has evaporated. Another method consists in dipping the
corks into very hot, though not boiling, paraffin for about five minutes,
and allowing them to dry thoroughly. — Journ. Denlaire Beige. (British
Journal of Denial Science)
Digitized by V:iOOQIC
QUBSTIONS AND ANSWERS 41
QUESTIONS AND ANSWERS
Question. — Some time ago I attempted to prepare and fill some cavities
for a relative (a boy of 8 years). He was rather unruly and so I had his
sister take him to another dentist, as I could see no way to prepare the
cavities except by using the dental engine. The cavities to be filled
were small pit and fissure cavities where an explorer would enter nicely.
When the boy returned I was informed by his sister that no engine
was used and all four ist molars were filled. Looks like a miracle to me.
I felt a bit delicate about the matter and asked no questions. Can you
suggest how such a stunt can be performed? Hope I have made a clear
impression as to the class of cavity. No other instrument than an ex-
plorer would enter for me. — R. C. M.
Answer. — ^Very frequently occlusal cavities that barely receive the
p)oint of an explorer will have the enamel pretty well undermined by
decayed dentine and in such cases the enamel can be quite easily broken
down with small sharp chisels and firm hand pressure, when the softened
dentine can be scooped out fairly well with spoon excavators; sufficiently
at any rate, to hold a filling for a few months or a few years. In fact I
think the main part of the opening up of all such cavities should be done
without the use of the dental engine. But unless the engine be used to
finish the operation, I think the preparation is apt to be quite incom-
plete, and it is more than likely that you will be called upon to refill those
cavities at some future time. — ^V. C. S.
Answer. — Will you add to your advice to '*H. B. W.'' in Septem-
ber issue. See to it that no iodine comes in contact with the tissues of
oral cavity (and all cleansing fluids have iodine) ; after repeated cleansing
he will see a marked improvement. — M. H. Cazier, M.D., Chicago.
Answer. — In reply to the inquiry of "R. C. M." (page 646, October
Digest), would say that if he will use a preparation that is sold under the
name of Velvo Phenox his troubles with children's teeth will be over. I
have used it very freely in all sensitive cavities for several years. It is
harmless. Stop it in with cement for two days before operating. — ^D. W.
Barker, D.D.S., Brooklyn, N. Y.
Question/ — Referring to question signed "R. C, Wisconsin": It is not
the policy of this magazine to publish any contribution not signed (for
the publisher) with full name and address of sender. — V. C. S.
Digitized by
Google
42 THE DENTAL DIGEST
AN EPITOME OF CURRENT DENTAL AND MEDICAL
LITERATURE
[The Journal of the National Denial Association, November, 1915]
Contents
G. V. Black, M.D., D.D.S., Sc.D., LL.D.
Original Communications
Greene Vardiman Black. By Charles E. Bentley, D.D.S.
The Research Department
The Organization of the Research Institute of the N. D. A.
By-Laws of the Research Institute of the N. D. A.
The Building and Endowment Fund Plan for the Research Institute of the N. D. A.
Research Department Announcements.
Dr. Greene Vardiman Black. By Weston A. Price, D.D.S.
Report of the Scientific Foundation and Research Conunission to the N. D. A.
•Report of the Minnesota Division of the Scientific Foundation and Research Commission.
By Thomas B. Hartzell, D.M.D., M.D.; Arthur T. Henrici, M.D.; Harold J. Leonard
D.D.S., B.A.
The First Report of a Study of the Composition and Properties of the Cements now in Use
in Dentistry. By Marcus L. Ward, D.D.S.; Ralph M. McCormick, B.S.
Proceedings of the House of Delegates
President's Address. By Donald Mackay Gallie, D.D.S.
First Session.
Proceedings of the Board of Trustees.
National Dental Association — Secretary's Cash Book.
Itemized Statement of Dbbursements.
Report of the Treasurer of the N. D. A.
Editorial
Greeting. By Thomas P. Hinman, President.
Greene Vardiman Black. By H. E. Friesell.
The Panama-Pacific Dental Congress. By Arthur M. Flood.
Conunercialism vs. Professional Ethics.
REPORT OF THE MINNESOTA DIVISION OF THE SCIENTIFIC FOUNDATION
AND RESEARCH COMMISSION
Oral infection, whether in the form of apical abscesses or pyorrhea,
is frequently the sole cause of arthritis and rheumatic affections of the
muscles and nerves as well as joints, and seems, when present, to be
always an associated cause where the rheumatism is of streptococcal origin.
An arthritis once started by tonsillitis or similar large foci, can be kept
going by an oral infection so slight as to be scarcely recogm'zable in the
Digitized by
Google
AN EPITOME OF CURRENT DENTAL AND MEDICAL LITERATURE 43
radiograph, and systemic diseases are continued by surprisingly shallow
gingivitis, even when the larger local foci, doubtless the originators of
the trouble, are removed.
Our experience in private practice, as well as in the cases shown by the
tables, has taught us that these rheumatic and arthritic conditions are
markedly improved by removing the local foci.
Great emphasis should be laid on the complete extirpation of infected
foci in all cases. It is not sufficient that the mouth or tonsils appear well'
from the outside. A minute examination with every means available is
necessary. With the aid of the X-Ray and careful exploration it is still
difficult to find all foci about the teeth. Without these aids it is im-
possible. When a physician refers a patient suflfering from rheimiatism
or other of the diseases liable to come from dental infection, it is impossible
for the dentist to make a complete determination without the use of the
X-Ray. It is our experience and the experience of others who use the
X-Ray a good deal that the majority of dental abscesses give no clinical
sign of their existence. The teeth are not sore, no swelling or palpable
soft spot at the root end reveals what the radiograph shows and what
the subsequent operation confirms. It is not uncommon to find ab-
cesses shown in the radiographs in cases in which there are no breaks in the
continuity of the pulpal wall, as under crowns, fillings, or even sound teeth.
Experience with a radiograph also shows that a very large propor-
tion of artificially filled roots subsequently become abscessed. A study
made by Dr. Henry Ulrich of this city of a thousand radiographs taken
at random indicated that over 70 per cent, of the artificially filled roots
were abscessed. It has been very rare that we have extracted a tooth
which showed an abscess in the radiograph and failed to get streptococci
when we cultured from the root end.
It is amazing to find in well cared for mouths how much pyorrhea may
exist without being evident except to painstaking exploration. To those
familiar with the systemic results coming from pyorrhea in such large
proportion of cases and even from a slight pyorrhea, the careless ignoring
and overlooking of such trouble on the part of most dentists, seems noth-
ing less than malpractice.
In all the cases which we have tested for bacteria, the streptococcus
viridens has been found in pyorrhea pockets and apical abscesses. Since
we have used the greatest precautions to prevent contamination from
the gum margin by searing them, there would seem to be no question but
that this organism is constantly present in such lesions. Whether it is
the etiologic micro-organism in the oral lesion or not, it is present and
there can be no doubt that it or its toxins pass thence into the circulation
and cause arthritis and rheumatic conditions.
Digitized by
Google
44 THE DENTAL DIGEST
The use of vaccines, however, is liable to create a confidence in them
which is likely to make the dentist less careful in eliminating all local
foci, and until such local foci are removed it can hardly be expected that
a vaccine will give any permanent relief. In most of the cases where we
were sure that all local foci were removed, the recovery was sujQSciently
rapid and complete to indicate that vaccine was not needed.
The heart cases studied are mostly endocarditis as evidenced by
valvular disease, usually insufficiency of the mitral valve . Most of these
are connected with rheumatic trouble.
In our table of hospital patients, thirty-five cases had a diagnosis
indicating endocarditis. Of these, twenty-three had or had had rheu-
matism, two had tuberculosis, nine were associated with nephritis, and
three with neuritis. The association of endocarditis with rheumatic
conditions is well known, this table merely serves to emphasize it. Of
the thirty-one cases who had or had had rheumatism, twenty-three had
endocarditis. All of these were wholly rheumatic cases, not complicated
by tuberculosis or syphilis.
The known and apparent relation of these heart lesions to rheumatic
conditions, the fact that all have dental infections, and the fact that so
large a proportion of the cases studied — thirty-five out of sixty-six —
have endocardial lesions, seems to us to be good clinical evidence of the
relation of such lesions to local infective foci of the dental type.
The response to treatment by foci removal in these cases is slow, but
in the great majority of cases is marked. These lesions are much like
the bony deformities of arthritis, in that although the disease may be
cured the scars remain and a heart valve once injured by inflammation is
always there after leaky and insufficient. The best that can be done is
to stop the progress of the disease and allow the heart to compensate.
Careful rest and slow building are necessary and quick results cannot be
expected.
The cases which have yielded us the most satisfactory results during
the last year have been those diagnosed as gastric ulcer.
[The Denial Register, November, 1915]
Contents
Event and Comment.
First General Annual Report of the Dental Department.
A Tribute to Dr. Chester Twitchell Stockwell.
Porcelain Facings.
Is Boric Acid Good for Babies?
The Importance of Sound Temporary Teeth to Facial Growth and Development.
Memorial Resolution.
Indents.
Announcements.
Meetinp3.
Digitized by
Google
AN EPITOME OF CURRENT DENTAL AND MEDICAL LITERATURE 45
[Tlie Dental Cosmos, December, 1915]
Original Communications
A Rational Appliance for the Correction of Palatal Defects, Based on Original Studies of
the Action of the Muscles of the Soft Palate. By W. H. O. McGehee, D.D.S., M. D.
Modern Attachments for Bridge Work and Stabilizers for Loose Teeth. By Jas. K. (Jur-
gess, D.D.S.
*Oral Infections. By Nathaniel Gildersleeve, M.D.
*A System of Making Jacket Porcelain Crowns Without Fusing. By L. E. Custer, A.M.,
D.D.S.
The Relation of Dentistry to Neurology. By Christopher C. Beling, M. D.
President's Address (Pennsylvania State Dental Society). By James G. Lane, D.D.S.
President's Address (New Jersey State Dental Society). By Walter F. Barry, D.D.S.
Correspondence
.\dvance Notice of the Use of the Fluid Extracts of Umckaloabo and Chijitse in the Treat-
ment of Pyorrhea Alveolaris.
Proceedings of Societies
Pennsylvania State Dental Society.
New Jersey State Dental Society.
Dentistry and the War
American Ambulance Hospital — Dental Department. First General Annual Report.
Editorial Department
Re-discovery.
Review of Current Dental Literature.
Periscope.
Hints, Queries, and Comments.
ORAL INFECTIONS
By Nathaniel Gildersleeve, M. D., Phil.adelphia, Pa.
(Read before the Pennsylvania State Dental Society, at its annual meeting, Reading,
June 22, 1915)
CAUSES FOR LACK OF PRESENT KNOWLEDGE OF MANY ORAL INFECTIONS
This lack of knowledge, it might be stated, is due primarily to four
causes:
(i) Lack of interest exhibited by physicians in local diseases of the
oral cavity.
(2) Lack of scientific education in a large proportion of dentists,
owing to which fact they have been handicapped in recognizing and
properly differentiating various infectious conditions of the mouth.
Those who have Qualified are in many respects self-educated, it being but
Digitized by
Google
46 THE DENTAL DIGEST
fair to state that the dental practitioner cannot be blamed so much as the
dental schools, since sufficient emphasis has not been laid on this very
important branch of oral medicine and surgery. This unfortunate con-
dition of aflairs is being corrected at the present time, and when the four
years' course is instituted in the various dental colleges, the student will
have better training in this as well as all other branches making up the
curriculum of our dental colleges.
(3) There has always existed an inexcusable lack of cooperation on
the part of medical and dental practitioners. The professional relation-
ships of these two bodies of men dealing with diseases of the human
economy are yearly becoming closer, each group recognizing more and
more fully the fact that they cannot work to the best advantage of their
patients without this essential cooperation.
(4) The fourth factor of importance is one which can only be over-
come by constant investigation, namely, there are numerous organisms
constantly existing in the oral cavity the true significance of which have
not been determined, owing to the fact that endeavors aimed toward
the isolation of some of these microscopic plants and animals have not
as yet been attended with success; furthermore, the importance of some
which have been isolated has undoubtedly not been fully recognized, due
partially to the haphazard way in which they have been handled by many
workers, and partially to the fact that some of the diseased conditions
cannot be reproduced in lower animals.
A RATION.\L APPLIANXE FOR THE CORRECTION OF PALATAL DEFECTS,
BASED ON ORIGINAL STUDIES OF THE ACTION OF THE MUSCLES
OF THE SOW PALATE
By W. H. O. McGehee, D.D.S., M.D., Cincinnati, Ohio
REQUIREMENTS OF A SUCCESSFUL OBTURATOR
It is now readily seen that a successful obturator should be capable,
not only of upward and downward movements, but, in order that it
may remain in perfect adaptation to the boundaries of the cleft under
all circumstances, should really possess six distinct movements, that is
to say, vertical (upward and downward), antero-posterior (forward and
backward), and lateral (right and left). The appliance described is
designed with this idea in view, and is presented to the profession after
adequate and successful trial in many clinical cases.
THE NEW CLEFT PALATE APPLIANCE, AND A NEW TECHNIQUE
FOR MAKING IT
The appliance suggested consists of a metal or vulcanite plate with
Digitized by V:iOOQIC
AN EPITOME OF CURRENT DENTAL AND MEDICAL LITERATURE 47
clasps, vulcanized or soldered into the heel of which is a clasp-metal
extension, on which rests the hard-rubber obturator. From the centre
of the metal extension projects upward through the obturator a screw-
cut gold post with a nut on its end. Vulcanized into the hollow portion
of the obturator is a flexible clasp metal tongue, through which the up-
right screw post previously mentioned passes and in contact with which
it is held by means of the nut on its end. On the under surface of this
metal tongue is a small gold hook, to which is attached one end of a
spiral spring, the other end hooking around the upright screw-cut post.
Another spiral spring extends from a similar hook, vulcanized into the
posterior part of the upper hollow portion of the obturator, to the same
upright post.
A SYSTEM OF MAKING JACKET PORCELAIN CROWNS WITHOUT
FUSING
By L. E. Custer, A.M., D.D.S., Dayton, Ohio
ADVANTAGES OF THE PORCELAIN JACKET CROWN
The jacket crown possesses certain features which easily place it at
the head of all other forms of porcelain crowns. First, the strength and
durability of this crown is testified to by every dentist who has made one.
Dr. W. A. Capon of Philadelphia says, ^* After many years of experience
with different kinds of porcelain jacket crowns, I am glad that I was
fortunate enough to recognize their efl&ciency early in my practice.
When a root has been crowned to death and considered only fit for ex-
traction, a jacket crown will give it renewed life and vigor in the majority
of cases, if it is decently firm in its socket."
Dr. Edward B. Spalding of Detroit says, *^The all-porcelain jacket
crown and its modifications have displaced all other forms of porcelain
crowns in my practice. The gum tissue is always more healthy about a
carefully fitted and flush joint than where a band is used."
Dr. George Schneider of Chicago says, ''There are two vital points
in favor of the jacket crown, namely, first it is not necessary to remove the
natural crown in whole; second, you do not endanger the root by en-
larging the canal for the retention of a post."
Dr. H. E. Jenkins of Ironton, Ohio, whom I have seen repeatedly
drive a canine jacket crown of his own make through an inch pine board
without damage to the crown, maintains and proves that it possesses
strength above any other form of porcelain crown.
The strength of the jacket crown is due largely to the natural post of
dentin within it, which is a part of the tooth itself. Where caries has
left but little dentin, this is reinforced by a platino-iridium post occupying
Digitized by
Google
48 THE DENTAL DIGEST
approximately the pulpal space of the tooth. We have never seen or
heard of a root split under a jacket crown. This cannot be said of any-
other form of porcelain crown.
A second advantage of the jacket crown, as pointed out by Dr.
Spalding, is that it makes a flush joint with the root at the cervix. A
metal band with its uncertain fit is thus done away with.
The third advantage is the esthetic appearance of the completed
crown. The entire crown itself performs the functions of a band, thus
eliminating the unsightly metal band at the gum line.
The disadvantages of the jacket crown lie entirely in the technique
of its construction. The operator must be skilled in the working of
porcelain, and I know of no procedure in dentistry that requires so high
a degree of skill and patience as the making of a porcelain jacket crown.
The platinum coping requires skill and time in its formation, the selection
and fusing of the proper shade of porcelain requires years of experience,
and then often at the last minute the esthetic appearance of the whole
appliance may be spoiled by overfusing. Another objection is the
amount of time consumed in the baking method.
It is a system or procedure in which the objections just enumerated
are overcome that I herewith present, and since I am the inventor of the
first electric oven, it may seem strange that I advocate a method which
does not require an oven, nor does it require any special instruments.
It will also be noticed that many steps of the technique are old and more
or less familiar to everyone.
[Items of Interest, December, 1915]
Exclusive Contributions
Is Tartar a Cause of Pyorrhea Alveolaris? T}ie Logical Test Applied. By G. F. Logan,
D.D.S.
Note on SUnding Amoeba in Dry Smears, from Cases of Pyorrhea. By Thomas LeClear.
ProstJwdontia
"The Application of the Chayes Parallelometer, the Parallelodrill and Attachments in the
Conservation of the Common Reciprocal Functions of the Teeth Which are Used as Piers
for Bridgework." By Herman E. S. Chayes, D.D.S.
Orthodontia
Some Principles of Retention. By Martin Dewey, M.D., D.D.S.
Discussion of Dr. Dewey's Paper.
Society Papers
♦Blood Findings in 162 Consecutive Cases of Chronic Oral Infection Associated with Teeth.
Bv Wm. H. G. Logan.
Digitized by
Google
AN EPITOME OF CURRENT DENTAL AND MEDICAL LITERATURE 49
•Oral Sepsis as Related to Systemic Disease. By W. H. Strietmann, M.D.
Operative Procedures in Relation to Dental Caries and Diseases of the Investing Tissues.
By Arthur D. Black, A.M., D.M., D.D.S.
BLOOD FINDINGS IN 162 CONSECUTIVE CASES OF CHRONIC ORAL INFECTION
ASSOCIATED WITH TEETH
By Wm. H. G. Logan
{Read before the Panama-Pacific Dental Congress j San Francisco ^ California, Section VI,
September i, 191 5)
In the examinations made in 100 out of 162 cases blood changes had
occurred that were held to be the sequence of chronic oral infections
associated with teeth.
ANEMIA
That neither pronounced nor moderate anemia was commonly
associated with chrom'c oral infections in this series, as claimed by many
authors; however pronounced anemia was found once.
leucopenia
That leucopenia was more constant than leucocytosis in pyorrhea
cases where the blood findings were abnormal; furthermore, leucopenia
was more frequent in those cases where the pyorrhea pockets did not
involve the root ends and in the absence of periapical focal infection
without discharging sinuses.
LEUCOCYTOSIS
That leucocytosis when associated with pyorrhea cases was most
frequent where the pyorrhea pockets extended nearly to or did involve
the root ends.
That abnormal blood findings were present in forty-eight of the one
hundred and ten pyorrhea cases examined. Full urinalysis was made of
all pyorrhea cases although not here reported.
That leucocytosis was present in forty-seven of the fifty-two cases
of {periapical infections without discharging sinuses — but that leucopenia
does occur under the same conditions is presented in Group 6. Let the
foregoing statement be not misconstrued to mean that either leucocytosis
or leucopenia is always present when a chronic periapical infection with-
out a discharging sinus is found, for periods arise when the effect of the
infective biproducts is so slight that its result is not manifested in a
blood change. But, since severe secondary infections could occur during
this period, a focal infection although producing no characteristic blood
Digitized by
Google
50 THE DENTAL DIGEST
change must always be looked upon as a menace to the health of the
patient and its eradication demanded.
PERIAPICAL INFECTIONS
One may have a pulpless tooth present without a rarefied periapical
area and at the same time have a chronic infective process in the rem-
nants of pulp tissue, which I have found in three cases to be account-
able for a serious secondary effect.
Nor can one with any degree of assurance eradicate periapical in-
fections by the mere extraction of teeth unless it be accompanied by a
currettement. Therefore it becomes necessary to do something more
than to extract teeth or amputate roots and do an indifferent curettement
to secure positive elimination of focal infections associated with teeth.
ORAL SEPSIS AS RELATED TO SYSTEMIC DISEASE
W. H. Strietmann, M.D., Oakland, California
(Read before the Panama-Pacific Dental Congress^ Section II y September 7, igiS»)
ETIOLOGY OF ROOT ABSCESSES
Let US consider on the other hand the etiology of root abscesses.
Here I would have you consider earnestly the causative factors spoken
of by Martin H. Fischer. He calls attention to the fact primarily that
teeth are living structures. All of us know that living tissue of any kind
is infinitely more resistant to infection than dead tissue. Hence any
procedure which would tend to interfere with the vitality of the tooth
or its surrounding structures must of necessity lower resistance to in-
fection and predispose to local disease. Under this heading we must
place the use of arsenic and strong antiseptics such as phenol tricresol,
etc. These substances destroy bacteria no doubt, but they destroy
living tissue as well.
Then comes the process known as devitalizing a tooth. The popular
conception is that this process removes the nerve from the pulp canal,
but as Fischer has pointed out, it also removes the nutrient artery from
the centre of a tooth, which naturally results in the death of the tooth
centrally, again producing a favorable ground for the growth of bacteria.
With the central canal deprived of its blood supply the pericementiun
alone is left to nourish the tooth, a thing which at best could be but very
imperfectly done, but with an existing pyorrhoea or the further dental
operation of placing a crown which necessitates the grinding away of the
convex sides of projecting portions of the teeth, thus destroying many
living cells again, it becomes an impossibility. Further the snugly fitting
crown causes a pressure necrosis of the underlying cells. Infection in-
Digitized by V:iOOQIC
AN EPITOME OF CURRENT DENTAL AND MEDICAL LITERATURE 51
variably occurs around such crowns and the primary focus of possible
subsequent systemic disease is planted.
The foregoing is not intended in any way to reflect upon the technique
of the dentist, the sterilization of hands and instruments, etc., for I am
firmly convinced that this precaution is becoming general among them.
Likewise devitalizing may be necessary for certain dental procedures now
in use, but I trust the inexhaustible ingenuity of the dental profession
will soon find a way to do without this method of treatment and indeed,
it is well known that dentists abhor the full gold crown as much as the
physicians, but find themselves compelled to use it in order to '*save a
tooth."
[The International Journal of Orthodontia, November, 19 15]
Contents
The Etiology and Treatment of Some Types of Deflected Nasal Septum. By Martin Dewey,
D.D.S., M.D., Kansas City, Mo.
The History of Orthodontia (Continued). By Bernhard W. Weinberger, D.D.S., New York
City.
Treatment of A Class II, Division i Case. By W. G. Barr, D.D.S., Wichita, Kas.
A Case History from Practice. By Hugh G. Tanzey D.D.S., Kansas City, Mo.
Current Orthodontic Literature
Some Infections of the Head and Their Causes. By J. Sheldon Clark, M.D.. Freeport, III.
Editorials
Dr. Stanton's Instrument for Surveying the Dental Arch.
Some Disputed Points in Orthodontic Treatment.
Dental and Medical Newspaper and Magazine Advertising.
[The Western Dental Journal, November, 1915]
Original Contributions
Conductive Anesthesia. By Dr. Arthur E. Smith.
R6sum6 of the Conductive Anesthesia Clinic. By Dr. Hinman.
Ethics and Good Taste. By Dr. C. C. Allen.
[Dominion Dental Journal, November, 1915]
Contents
Original Communications
Clean Hands. By Jas. M. Magee, D.D.S., L.D.S., St. John, N.B.
Addresses of Welcome, New Brunswick Dental Society.
Replies to addresses.
Digitized by V:iOOQIC
52 THE DENTAL DIGEST
President's Address—New Brunswick Dental Association. By W. P. Bonnell, D.D.S.,
L.D.S.
A Trip in War Times. By A. W. Thornton, D.D.S., L.D.S., Montreal.
Denial Societies
Reports of Committees, New Brunswick Dental Society.
The Annual Convention of the New Brunswick Dental Society.
Oral Hygiene Conference in Toronto.
Toronto Dental Society.
Canadian Army Dental Corps.
National Dental Association.
Editorial
*Desensitizing Dentine with Paraform.
The Annual Fee of the Royal College of Dental Surgeons of Ontario.
Quebec Again Refuses to Enter Dominion Dental Council.
Dr. J. Burkhart Appointed.
Editorial Notes.
Selections
Army Forms and Regimental Teeth.
Dental Treatment for the Troops.
Reviews
Alveolodental Pyorrhea. By Chas. C. Bass, M.D.
Obituary
The late Dr. Chas. W. Brown.
The late Dr. W. T. Stuart.
DESENSITIZING DENTINE WITH PARAFORM
Equal parts of paraform and cocaine crystals were moistened to a
paste with oil of cloves and applied to an almost exposed pulp of a first
permanent molar of a child ten years old. The pulp had to be devital-
ized, so it was first used to try the effect of cocaine and paraform on it.
The paste was sealed into the cavity with cement for about a week. There
was neither pain nor soreness during that time. When the dressing was
removed the decalcified dentine which had been exceedingly sensitive was
readily excavated without pain, and the horns of the pulp cut with free-
dom, though the tissue was quite sensitive below. The same application
was made in many deep cavities in which there was no pulp exposure; in
very few of these was there the slightest discomfort, and in most cases
happy results on the dentine. In shallow cavities there is less need of the
cocaine and greater difficulty in sealing, so less cocaine may be used and
more paraform. The proportion of cocaine and paraform is governed
Digitized by
Google
AN EPITOME OF CURRENT DENTAL AND MEDICAL UTERATURE 53
by the state of the sensitiveness of the pulp and the nearness to it. The
length of time to leave the application is governed by the amount brought
into actual contact with vital dentine. In shallow cavities equal parts
of the cement powder and paraform may be mixed with the liquid and
inserted, but if the pulp has been irritated for any reason much less
paraform must be used. If a small amount of the paraform is brought
in contact with the tooth's surface, then leave it even weeks, but on the
other hand if a large percentage has been brought in contact then days
may suffice. It is wise to remove whatever decay possible before apply-
ing, but if success does not come with one application and there has been
no irritation increase the percentage in another application. The pene-
tration of the drug is not very deep, one or two millimeters is the limit,
and it does not spread laterally more than the anastomosis of the tubules.
If it is applied to one surface of a tooth it won't desensitize the opposite
surface.
If the profession will carefully test out the value of paraform as a
means of desensitizing dentine and report the results it will not be long
until its true place will be known to all. An ounce bottle of paraform
costs about thirty cents. It is a yellowish-white crystalline powder,
with a peculiar odor. Try it.
[The Dental Outlook, December, 1915]
Original Communications
•Treatment and Filling of Root Canals. By Dr. R. Ottolengui.
Balanced Alloys. By N. K. Garhart.
Dentistry and System. By S. Herder, D.D.S.
"Sweatshop Dentists." By Dr. M. Schneer.
The Dental Student and the Profession. By Morris Zucker.
Gateways of Infection.
A Mother's Thought on the War. By Bert Ullad.
Our Good Friend, the Dentist. By Arthur Brooks Baker.
Monthly Report of Legislation Committee of the Allied Dental Council.
Hold Man and Woman Practicing Without Licenses.
TREATMENT AND FU-LING OF ROOT CANALS
By R. Ottolengui, New York
The Alternative for the Surgical Treatment of Root Ends is Ionization
The action of the electric current in an electrolyte is to split it up
chemically into simpler materials which move to their respective elec-
trodes. These materials are called ions. The ion is the conveyor of
electricity; hence the ion which travels to the anode is called the anion,
and the ion which goes to the cathode is called the cation. The use of
Digitized by
Google
54 THE DENTAL DIGEST
medicaments by ionization has been much more studied abroad than by
American dentists. Clinical results are sufficiently satisfactory to
make it highly probable that in the ionization of tissues through the
canals of teeth we have a very promising method of controlling even
serious infectious conditions.
Abroad the method employed mainly is to use a platinum point as
the anode, and to flood the canal with chloride of zinc. The method
advocated by Rhein and others in this country, and thus far the only
method tested by myself, is to use an anode of pure zinc and to flood the
canal with normal salt solution. When a current is passed through an
electrolyte containing a salt in solution the metals, or metallic radicals
move from the anode to the cathode; thus by using the zinc point as the
anode, the ions pass from the zinc through the apical foramen and act
upon the tissues about and beyond the apex.
Tests out of the mouth easily demonstrate that the result, say upon a
bit of beef, is much the same as where chloride of zinc is used; markedly
escharotic. In twenty minutes a cubic quarter inch of fresh beef may
thus be so disintegrated by ionization that it can be easily macerated be-
tween the thumb and the forefinger. Hence if a true granuloma be
present in the apical space, caused by septic infection, this granuloma
may thus be destroyed, and the theory is that it is then absorbed and
slowly replaced by normal tissue.
It is also claimed that ionization with the zinc used in combinaton
with normal salt, will sterilize dentine and cementum, as well as the tissues
about and beyond the apical foramen.
[The Texas Dental Journal, November, 1915]
Original Communications
Some Practical Points.
Thirty-first Annual Convention of the Texas State Dental Association.
Professional Ethics.
Dental Radiography.
Taking Impressions.
[The Pacific Dental Gazette, November, 1915]
Contents
Original Articles
Local Anesthesia in Dental Surgery. By Otteson.
A Symposium on the Ameba Buccal is. By Gray.
Digitized by
Google
AN EPITOME OF CURRENT DENTAL AND MEDICAL LITERATURE 55
Editorial
A Pedagogic Duty or a Necessity?
Reviews of Domestic and Foreign Dental Literature
Mouth Hygiene.
Selections
The Significance to the Dentist of Oral Infections in Their Relation to Systemic Disorders.
By Gibner.
The Relation of the Internal Secretory Organs to Malocclusion, Facial Deformity, and Dental
Disease. By Grieves.
Mercurial Stomatitis.
Reminiscences by Dr. Asay.
Dental Excerpts
Special Article
[Oral Health, November, 1915]
Photograph, Major A. A. Smith, Acting Chief Dental Surgeon, C.A.D.C.
*The Progress of the Research Commission of the National Dental Association. By Weston
A. Price, D.D.S., M.S., Cleveland.
Six Years of X-Ray in Dentistry. By Stephen Palmer, D.D.S., Poughkeepsie.
Quarterly Report, Canadian Army Dental Corps.
Society Announcements.
Summary of Dental Laws of Canadian Provinces.
The Compendium.
The Active Service Roll.
Multum in Parvo.
Editorial.
THE PROGRESS OF THE RESEARCH COMMISSION OF THE NATION.AL DENTAL
ASSOCIATION
By Weston A. PiacE, D.D.S., M.S., Cleveland, Ohio
The research department is giving support to the solving of metal-
lurgical problems, and I think I am justified in telling you that one
third of the platinum used in the world is used in the practice and art of
dentistry, and do you realize that for the dental profession it amounts
to $2,500,000 annually? If we would utilize the opportunity and the
information we have on the tungsten product which has been developed
through our Research Commission, it would result in great benefit and
good to the dental profession. This metal is six times as strong as iridio-
platinum; it has a melting point nearly twice as high as that of platinum ;
its elasticity is twice as great as that of steel. It has a hardness so much
Digitized by
Google
56 THE DENTAL DIGEST
greater than that of steel that the management of the General Electric
Company is responsible for the statement that one tungsten point will
outwear two hundred steel points. It is a metal that does not lose its
elasticity when you heat it. This metal is available for any man in this
room for use in making posts for crowns and for casting bridges upon.
It is so stiff and rigid that you can make a framework of it and cast about
it and control the contraction that will take place in casting a bridge with
its abutments, all at the same time. You may use it for orthodontia
appliances either by the method which has been presented by Dr. Robin-
son or by the standard methods.
Relative to the application of the metal in orthodontia appliances,
I am advised that it is destined to supplant largely the metals that are
in use up to this time for orthodontic work. With its greater elasticity,
you can make attachments to it with hard gold solder. It has the
property of enormous strength; it does not break off like clasp metal
wires by crystallization. You m^y use wire that is so much smaller
that it seems incredible for it to accomplish the work it does.
Any dentist who will write to the commission can get the metal. We
are furnishing it to the profession at what it costs us to produce it,
and ultimately the manufacturers will make it. The selling price is
virtually one sixth of that of platinum for the same weight.
In the last two or three months our research department has been
able to furnish the profession enough tungsten to supplant the use of
platinum to go far toward paying for the research expense that the com-
mission has gone to for that particular line of research work. (Applause.)
There are only a few who know about it, because you have not read
the recent issues of the Journal of the National Dental Association with
reference to the research work we have been doing in regard to this metal.
As to palladium, it requires no special preparation. Any man can
send to the American Platinum Works, New Jersey, and buy palladium
for $48 an ounce. You can get twice the bulk for the same weight that
you can with platinum. You can make it equivalent to platinum at
$26 an ounce.
{British Dental Journal, November i, 191 5]
Contents
Original Communications
A Review of Recent Researches concerning the Nature of Dental Caries. By W. H.
Jones (Downing College, Cambridge), B. A. Cantab., L.D.S., Eng.
* Presidential Inaugural Address.
Digitized by
Google
AN EPITOME OF CURRENT DENTAL AND MEDICAL LITERATURE 57
Selected Article
" Diagnosis of Ulcers of the Tongue." By E. C. Hughes, M.C., F.R.C.S.
Editorial
•Annual Report of Chief Medical Officer, Board of Education, for 1914.
News and Comments
Lord Derby's Appeal.
The War.
Contents of this Number.
The National Insurance Act.
The Royal Dental Hospital.
The Dental Curriculum.
Christmas-in-Wartime Sale.
Chronic Cervical Adenitis.
The Dental Profession and the War
Four Brothers.
Second-Lieutenant R. H. Basker, L.D.S., Killed in Action.
Exhibition or Fracture Apparatus at the Royal Society of Medicine.
A Prophylactic Interdental Splint.
Professor Dr. Dependorf killed.
Germany's Need of Dentists.
Dundee Dental Hospital.
Current Dental Literature.
PRESIDENTIAL INAUGURAL ADDRESS*
By Reginald E. Bascombe, L.D.S., Eng.
Each day we notice the slow but sure progress that is being made,
and this war has already done more than the last decade of peace to teach
a great national lesson — that "the care of the teeth'* is the very hypo-
thesis upon which health, strength, the power to endure, the length of
life itself wholly and entirely depend. So, out of evil comes good; the
powers that be have discovered in a time of stress that this war will be a
true case of survival of the fittest, that half the troubles of the soldier
are due to want of knowledge, that the care of the teeth comes before all
else; and so with feverish haste nearly three millions of men are being
put under the skilful treatment of the specialist. Here let me remark in
parenthesis that it is the duty of every qualified practitioner, while
doing his utmost for the men who go forth to save our homes, at the
same time to teach each man with care and patience the necessity for
constant cleanliness and annual supervision at the hands of the qualified
dentist.
These common soldiers are for the most part splendid men with
•Delivered before the Eastern counties Branch at Bury St. Edmund's on September 24, 1915.
Digitized by V:iOOQIC
58 THB DENTAL DIGEST
hearts of gold, and I have been overwhelmed by the tokens of gratitude
which I have received at their hands. So many men have spoken of
their gratitude to the Government which has enabled their eyes to be
opened, and oft I have heard it said, "If only my parents had taught me
to clean my teeth! I thought, indeed, that dentists were only to remove
teeth when at last they became unbearable by reason of the pain they
gave!*' So here is a boon to mankind; the hour of peril has caused the
slow-geared cogs of evolution to leap forward half a century. These men
will never forget, and they will see that their children profit by the lessons
which they are being taught to-day. Mr. Bailey is a man who gave
his all freely to help in the great fight to enable our profession to take that
high position which it has earned for itself by self-sacrificing endeavor.
He deserves our gratitude for his honest convictions as to the necessity
of systematic dental treatment for the poor. The fervor for the cause
he has inspired by his efforts is echoed in the clinics we see springing up
around us.
ANNUAL REPORT OF CHIEF MEDICAL OFFICER, BOARD OF EDUCATION
FOR 19 14
In regard to the Dental Treatment Scheme, 130 areas are now sanc-
tioned, as compared with 88 in the preceding year, and that no fewer than
195 organized dental clinics now exist, as compared with 150 in the pre-
ceding year. The number of dentists employed was approximately 200,
of whom but 51 were full-time officers. The report calculates that the
provision is sufficient to undertake the treatment of 37s, 000 children. In
London alone upward of 42,000 children are now provided for annually,
an increase of nearly 11,000 as compared with the preceding year, and
this in spite of war difficulties.
Over and above the ordinary stationary dental clinics, "traveling
clinics" have been instituted in Devon, Norfolk, and the West Riding
of Yorkshire; in Norfolk the dental work is actually carried out in a
dental caravan, though to our disappointment little is said as to whether
this plan is a success or not. In Devonshire and the West Riding of
Yorkshire the dental equipment is carried from place to place.
[British Dental Journal, November 15, 1915]
Original Communications
A Review of Recent Researches concerning the Nature of Dental Caries. By W. H. Jones
(Downing College, Cambridge), B. A. Cantab., L.D.S., Eng.
Surgical Prosthesis of the Jaws. By H. Watson Turner, M.R.C.S., L.R.C.P., L.D.S.
Digitized by
Google
AN EPITOME OF CURRENT DENTAL AND MEDICAL LITERATURE 59
Editorial
"On Surgical Prosthesis."
News and Comments
Dentists and Lord Derby's Recruiting Appeal.
Contents of this Number.
The R. C. S. Museum Demonstrations.
To Photographers.
L. C. C. Economies.
A Medical Officer on Unqualified Practice.
Tokyo Dental College.
^Russian Women Dentists.
The Dental Profession and the War
Dental Pupil Killed in Action.
The Kaiser's Dentist.
Dental Student Promoted.
House of Commons — Answers to Questions.
The Case of Dental Students.
The Position of Dentists at War Hospitals.
Dentistry for the Troops at Doncaster.
Dentists' War Relief Fund.
RUSSIAN WOMEN DENTISTS
In view of our growing interest in Russian affairs, a note on dental
conditions in that great Empire may be opportune. In Russia dentistry
is regarded as one of the best professions for women, who are estimated
to constitute 90 per cent, of dental practitioners. The chief school is the
Dental College at Petrograd, which has 600 students, less than 5 per
cent, of whom are men. There are also large dental colleges at Moscow,
Odessa, Kiev, and Warsaw. Before entering upon the three years'
dental course the student is required to have matriculated. The fees
amount to £20 per year and the State diploma costs £2, a license to
practise being only granted on proof of qualification. The first year's
studies are devoted to mechanical dentistry; in subsequent years the
student does clinical work from 10 to 5, and lectures follow until 9 p.m.
Examinations are held every month. The lecturers at Petrograd num-
ber about twelve and come from the Imperial University Faculty of
Medicine, while the ten demonstrators are chiefly women. For both
medicine and dentistry fees in Russia are considerably lower than in this
coimtry, and hours of work are also longer. Men seem to prefer to enter
the medical profession, and it is said that even in the capital city of
Petrograd the men dentists of standing do not number more than half-
a-dozen.
Digitized by
Google
60 THE DENTAL DIGEST
[New York Medical Journal, November 27, iQisl
REMEDIABLE DEFECTS IN SCHOOL CHILDREN
Supplement No. 25 to the Public Health Reports for July 30, 1915,
consists of a study of school hygiene in Manatee County, Fla., by Surgeon
J. A. Nydegger. After describing the country, the school buildings,
their environment, drainage, outhouses, drinking and lighting facilities,
ventilation, etc., the writer takes up the health of the children. Apart
from trachoma, the treatment of which requires great care and patience,
together with the personal attention of the surgeon, the principal troubles
found were adenoids, enlarged tonsils, defective teeth, and hookworm.
The writer points out that the special object of his survey was to investi-
gate communicable disease, but that other conditions were also studied,
including ground itch, deformities of the back and limbs, defective vision
and hearing, poor physique, dullness and backwardness, etc.
In the 1,684 school children examined, says Surgeon Nydegger in his
report, 426 or 26.03 P^r cent., had defective teeth, ranging from a single
tooth to three or four or more. A condition of the teeth noted to exist
in the children of several schools, but mostly in the town schools, was the
loss of the enamel from a portion of the surface of one tooth or several
teeth in one individual. In some cases the enamel was noticed to have
disappeared from the entire biting surfaces, while in others it was de-
stroyed elsewhere. It is believed that this condition results from the
prolonged action of acids on the teeth, such as would be brought about
largely by the consumption of oranges and grape fruit, extending over a
long period. The good result of dental inspection of school children was
well exhibited in the Sarasota schools, where it was instituted during the
present year. In the 279 children examined at the time of the visit but
one case of defective teeth was discovered. This is in decided contrast
with the findings at the Palmetto schools, which showed 22 per cent,
of the children to be suffering from defective teeth. It would have
been interesting to have had a special note on the teeth of colored
children.
Two hundred and seventy-four children, or 16.2 per cent., had en-
larged tonsils, while 164 children, or 9 per cent., had adenoids. There
was a noticeable difference in the proportion of enlarged tonsils observed
in school children in towns from those in the rural schools, in favor of the
latter. The children examined in the colored schools, numbering 243,
were noted to be particularly exempt from enlarged tonsils and adenoids.
Two hundred and thirty- three children, or 13.24 per cent, of the total
number examined, had adenoids. The figures show a preponderance of
5.6 per cent, more cases in the town schools than in the county schools.
Digitized by V:iOOQIC
AN EPITOME OF CURRENT DENTAL AND MEDICAL LITERATURE 61
In 243 children examined in the two colored schools there were 13 cases,
or 5.3 per cent.
We have found this report on adenoids, enlarged tonsils, and de-
fective teeth of special interest because these conditions would never be
met with by a medical inspector if the general intelligence of the com-
munity was what it should be. It seems to us that the dentists and phy-
sicians in various parts of the country should organize some sort of an
educational campaign, having for its object the bringing of the children
for inspection every six months or so. Oral and pharyngeal lesions have
a direct bearing on the nutrition and growth of the child and the treat-
ment should really be prophylactic only and begin at the time of weaning.
Surgeon Nydegger's best impressions of his survey, however, were con-
veyed by the joyous, laughing, romping assemblages of happy school
children encountered at each school visited, which of itself was proof
sufficient of generally well nourished and vigorous bodies. It was a
real treat, he says, to mingle with these alert and vivacious young Ameri-
cans, so intent on catching each word spoken to them.
ACADEMIC FREEDOM
In his annual report to the trustees of Columbia University, President
Nicholas Murray Butler tells of numerous criticisms of public utterances
of members of the faculty which have reached him from outside the
university. These criticisms are, as a rule, based on incorrect or garbled
reports of what the professor really said, or indicate a desire on the part
of the critic to use the university as a medium for some particular propa-
ganda. The critic usually demands the instant removal of the offending
faculty member from the roll of the imiversity.
In conmienting on this regrettable attitude. Professor Butler wisely
says: "The last thing that many persons want is freedom of speech or
of anything else unless its exercise happens to accord with their somewhat
violent and passionate predilections."
There is a tendency in medicine toward the same kind of criticism as
that complained of by President Butler, and in medical publications we
must carefully conserve freedom of speech and of views if we expect to
make progress. We must, above all else, avoid the suppression of truth
through the exercise of the "somewhat violent and passionate pre-
dilections " of those who would limit the freedom of speech in medicine
within the compass of their own narrow knowledge and sympathies.
[Journal American Medical Association, November 13, 1915]
THE LOCALIZATION OF STREPTOCOCCI
The relation to infection of the affinity of bacteria for certain tissues
Digitized by
Google
62 THB DBNTAL DIGEST
was discussed recently in these columns.^ It was pointed out that many
of the pathogenic bacteria in their localization manifest a special affinity
for some particular tissue or tissues. This elective localization may be
conceived to be due to the circumstance that the conditions for growth
are more favorable in some tissues than in others. On account of
differences in metabolism and chemical composition, there is no doubt
that different tissues and places in the body present radically different
conditions for bacterial growth and activity. It was pointed out, further,
that the work of Forssner and especially the more recent work of Rose-
now have established that among the streptococci, which have the power
to invade many tissues and to cause a variety of infections, strains may
appear which, when introduced into the blood, are found to localize by
preference in certain tissues. It his article in this issue of The Journal^
Rosenow^ presents a summary of the results of his experiments of elective
localization of streptococci obtained from a wide range of human infec-
tions and injected intravenously into dogs and rabbits. The animals
were killed soon after the injection, and the facts as to localization of the
streptococci determined by systematic, careful examination of the whole
body. Obviously this method gives a much better idea of early localiza-
tion than can be obtained if only the animals that die are examined.
Stated in the simplest way, the results obtained by Rosenow with his
method show (i) that streptococci isolated from active lesions in different
human organs and tissues, in many instances, have a pronounced affinity
for the corresponding organs and tissues in rabbits and dogs, and (2) that
streptococci isolated from the tonsils and pyorrheal pockets in persons
with active streptococcal infection in the interior of the body may have
the same sort of affinities as the streptococci from the internal lesions.
In the light of these results, many of which are striking indeed, as may be
seen at a glance from the table in Rosenow*s article, human strepto-
coccus infections acquire new interest because a road now opens to a
better understanding of their genesis and of the difficulties of curing them
by the specific means now in use. Obviously a chief danger from chronic
foci in which streptococci are present, of which those in the tonsils and
about the teeth appear to be the most important because the most com-
mon, seems to depend on the fact that in such foci, even when quiescent,
streptococci may get into biochemical conditions which fit them for in-
vasion of the blood, to be followed by localization in some tissues rather
than in others. Persons going about with chronic, more or less latent
'The Relation of Selective Tissue Affinity to Infection, editorial, The Journal A. M. A.,
Sept. 26, 1915, p. 1 1 14.
*Rosenow, E. C: Elective Localization of Streptococci, The Journal A. M, ^4., this
issue, p. 1687.
Digitized by
Google
AN EPITOME OF CURRENT DENTAL AND MEDICAL LITERATURE 63
fod of this character, consequently, are not only dangerous to themselves
in that what one may call internal streptococcal metastasis may occur at
any time, but they are also undoubtedly dangerous to others because
they scatter about them streptococci of specialized pathogenic possi-
bilities. Hence the efforts now made to detect and then to obliterate
all forms of focal infection in the mouth and throat as well as elsewhere
in the body, for preventive as well as curative purposes, besides being in
accord with sound reasoning from general principles, here receive the
support also of strong experimental evidence. When we consider the
wide range of action of pathogenic streptococci, the great variety of
disease due to their localizations in different tissues according to what
Rosenow's work indicates are states of special "elective aflBmities," no
effort should be spared that in any way will tend to reduce the supply of
such streptococci and lessen the chance of infection.
PYORRHEA DUE TO ORGANISMS OTHER THAN THE AMEBAS
By George Howard Hoxie, A.M., M.D., Kansas City, Mo.
Since the publication of the work of Bass and Johns on pyorrhea,
there has seemed to be a tendency among dentists and many medical
men to administer emetin in all cases of dental infections without estab-
lishing the presence of the endameba. That the endameba is not the
cause of all cases diagnosed as pyorrhea by competent dentists is shown
by this following summary of a case treated by this author.
W2 have to do with a recurrent fever of about seventeen days' dura-
tion. The focus has been the alveolar processes and the mucosa of the
mouth, from which the body has been invaded. The particular parts,
aside from the mouth, which have shown evidences of infection, have
been the left knee (bursitis) and the anal fold (abscesses). The length
of the attacks has varied from three to ten days. The organisms most
constantly found have been a diplo-streptococcus and a mold. The
disease has proved resistant to arsenic (salvarsan, arsacetin and the tri-
oxid), the salicylates and other systemic and local germicides, as well as
to vaccines, both autogenous and stock, single, as well as mixed.
The question of great interest is whether we have to do with an
organism showing a cycle of from fourteen to seventeen days, or whether
it is a case of temporary immunity. Repeated examinations have failed
to reveal any amebas. Animal inoculation was negative.
To me it would appear that the causative organism is one which is
ordinarily nonpathogenic, but which has acquired parasitic power in the
tissues of this patient.
It is perhaps needless to say that all the conventional drugs have been
used at one time or another by the various physicians who have treated
Digitized by
Google
64 THE DBNTAL DIGEST
the patient. The dentists employed have been the best in the dty. The
case was worked up from the dermatologic standpoint by Dr. R. L. Sut-
ton, and published under the caption ''Periadenitis Mucosa Necrotica
Recurrens." The diagnosis of pyorrhea was given by all the dental
attendants, including Dr. Frederick Hecker, the author of a monograph
on that subject.
1334 RiALTO Building.
[Deuisches Archiv. fur Klinische Medizin, Leipsig, July 20]
MECHANISM OF INJURY FROM GETTING CHILLED
Auf recht presents an imposing array of testimony culled from old and
modem writers to reaffirm the important part played by getting chilled
in the genesis of various diseases and morbid processes. He then reports
various experiments on rabbits, all of which confirms his assumption
that the chilling causes coagulation of fibrin in the blood stream in the
part chilled. The cause of the coagulation is the injury done to the
white corpuscles by the cold. The coagulation obstructs the flow through
the peripheral vessels involved and the blood is liable to back up into the
liver, kidneys, and gastric mucosa. The most striking changes were
found in the lungs, the coagulation of fibrin entailing microscopic hem-
orrhage into the interstitial tissue. This occurred in a pronounced form
when the hind part of the rabbit was thrice dipped into ice water for ten
minutes. The blood chilled in this way passes in the directest way to the
arterial circulation in the lungs. The obstruction of vessels by the coagu-
lated fibrin after chilling may be transitory and harmless, but, on the other
hand, it may provide a culture medium for germs and explain pneu-
monia developing after exposure to cold. The hyperemia in the internal
organs may also cooperate in the disturbances following chilling.
[Journal American Medical Association, November 20, 191 5]
[Berliner Klinische Wochenschrift, October 11]
CANCER OF THE MOUTH AND RADIUM TREATMENT
Sticker reports fifteen cases in most of which malignant disease of
the mouth retrogressed under radium treatment without scars or mutila-
tion. The list includes some cases of recurrence after operations. He
declares further that radiotherapy is preferable to surgical treatment in
many cases for technical reasons and also from the standpoint of im-
munity. This statement is based on experimental research which demon-
strated that it is possible to induce an implantation tumor on laboratory
Digitized by
Google
AN EPITOMB OF CURRENT DENTAL AND MEDICAL LITERATURE 65
animals in various different organs and points, inoculated all at the same
time, but that, after having been once successfully inoculated, it is
impossible to induce further growths by later implantation of tumor cells
at any point. After complete excision of the implantation tumor, how-
ever, a new implant "takes" at any and every point inoculated all at the
same time. On the other hand, if the implantation tumor was only
partly excised and it continued to grow, subsequent implantations gave
constantly negative results. These experimental data correspond to what
is observed in the clinic during the period preceding metastasis. The
cancer long remains solitary, and, especially with cancer in mucous mem-
branes, notwithstanding the constant opportunities for implantation of
tumor cells farther along, the mucosa beyond is generally free from
metastases, even with extensive ulceration. After vaginal hysterectomy
for cancer of the uterus, he continues, recurrence in the vagina is not
uncommon, while metastases in the vagina, with the uterine cancer still
present, are extremely rare.
These and similar data cited are alleged to explain why radiotherapy is
more promising in certain cases than surgical removal of the focus.
Under the radiotherapy, the cancer cells being gradually destroyed and
passing into the circulation, cause a lively production of antibodies, and
these protecting substances combat the growth of any new cancer cells.
The antibodies thus generated are similar in nature to the autolysates of
cancer cells which some are using now in treatment of cancer. None of
the experiences in this line reported to date, however, make the distinc-
tion which he emphasizes between the periods before and during meta-
stasis. The nonheeding of this fundamental distinction readily explains
the unsatisfactory results to date. It is by no means immaterial whether
the tumor autolysates are taken from the body while it is still engaged in
producing antibodies, that is, during the premetastasis stage, or whether
the material is not taken until after the body has lost its capacity for
antibody production.
He describes his fifteen cases in detail; in three the cancer was on the
tongue and the radium induced a clinical cure. In one case, only seven
twelve-hour exposures, all at night, accomplished the purpose, the cancer-
ous crater healing completely in a few weeks. In seven cases the cancer
was in the lower jaw and in five others in the upper jaw. The radium was
fastened in a plate made to fit over the upper or lower teeth. One patient
wore this for thirty nights' exposures, and it did not interfere with his
sleep. In two other cases the cancer was a recurrence after one or several
operations. By modifying the tooth-plate-holder it was possible to
apply the rays in various directions thus facilitating the cure.
Digitized by
Google
Simplex Hand Book of Dental Materia Medica and Therapeutics.
By Alfred and Wesley Barrett. Oblong i6mo. 350 pages.
Price, $1.75 net. Publisher, Peter Reilly, Philadelphia, Pa.
A simple, tabulated classification of Drugs and Remedies used in
Dental Operations and the Treatment of Dental Diseases; specially
adapted to the requirements of students and busy practitioners.
A great mass of facts are brought together in alphabetical order
which will be appreciated and save valuable time in making reference.
The authors have spared no pains in endeavoring to make this the
best work of its kind.
BOOKS RECEIVED
Carnegie Endowment for International Peace, Division of Inter-
course and Education, Publication No. 7. For Better Relations
With Our Latin American Neighbors. A Journey to South
America. By Robert Bacon, Washington, D. C.
Carnegie Endowment for International Peace, Founded Decem-
ber 14, 1910. Year Book for 19JS, Washington, D. C.
DR. DWIGHT TRACY
Dr. Dwight Tracy died November 7, 191 5. He was well known in
New York City and was most successful in his profession.
Dr. Tracy leaves a son who is also a dentist of note.
A. STILL WELL
Mr. A. Stillwell, a valued employee of The Temple-Pattison Co., Ltd.,
Ont., Canada, died Friday November 26th, 191 5 after a very painful
illness.
He was a man who took a great interest in the welfare of the dentist,
and was the oldest dental salesman in the Dominion of Canada. He
was connected with the old firm of the S. B. Chandler Co., over 28
years ago, and ever since that time he has been identified with the den-
tal supply business. The Temple-Pattison Company deeply feel his loss,
as must, also, his numerous friends.
Digitized by
Google
SOCIETY NOTES 67
SOCIETY NOTES
District of Columbia.
The next examination of applicants for license to practise in the District of Columbia, will
be held at the George Washington University, Washington, January 3-6, 191 6. Appli-
cations should be in the hands of the secretary two weeks before the date of the examina-
tion. Fee $10— Stakr Parsons, 1309 L Street, N. W., Washington, Secretary.
Minnesota.
The thirty-third annual convention of the Minnesota State Dental Association will be
held at the University of Minnesota, in Minneapolis, February 11-12, 1916. — Max
E. EiiNST, 614 Lowry Bldg., St. Paul, Minn., Secretary.
The annual meeting of the American Institute of Dental Teachers will be held at
Hotel Radisson, Minneapolis, January 25, 26, and 27, 1916. — ^J. F. Biddle, Secretary,
Missouri.
The next meeting of the Washington University Dental Alumni Association will be held
at the University Dental School, February 21-22, 1916. — H. M. Fisher, Metropolitan
Bldg., St. Louis, Mo., Secretary.
North Carolina.
The next meeting of the North Carolina State Board of Dental Examiners will be held
at Salisbury, N. C, begiiming promptly at 9.00 o'clock on Thursday, January 13, 191 6.
For further information and application blanks address the Secretary, F. L. Hunt, Ashe-
ville, N. C.
North Dakota
The next meeting of the North Dakota State Board of Dental Examiners will be held
at Fargo, N. Dak., January 11, 1916. For further information address, W. E. Hock-
ing, Devil's Lake, N. D.
South Dakota.
The South Dakota State Board of Dental Examiners will hold its next meeting at Sioux
Falls, So. Dak., January 11, 1916, at 9 a.m. sharp, continuing three days. All appli-
cations must be in the hands of the Secretary by January ist. Fee $25. Aris L.
Revell, Lead, So. Dak., Secretary.
Wisconsin.
The next meeting of the Wisconsin State Dental Society will be held in Wausau, Wis.,
July 11-13, 1916. — ^Theo. L. Gilbertson, Secretary.
FUTURE EVENTS
January 3-6, 19 16. — Board of Dental Examiners for the District of Columbia, George Wash-
ington University, Washington. — Starr Parsons, 1309 L Street, N. W., Secretary.
January 11, 1916. — South Dakota State Board of Dental Examiners, Sioux Falls, So. Dak. —
Aris L. Revell, Lead, S. D., Secretary.
January 10-13, 1916. — Montana State Board Dental Examiners. — G. A. Chevigney, Secre-
tary.
January 11, 1916. — North Dakota State Board of Dental Examiners, Fargo, N. Dakota. —
W. E. Hocking, Devils Lake, N. D., Secretary.
Digitized by
Google
68 THE DENTAL DIGEST
January 13, 1916. — ^North Carolina State Board of Dental Examiners, Salisbury, N. C. —
F. L. Hunt, Asheville, N. C, Secreiary,
January 25-27, 1916. — American Institute of Dental Teachers, Minneapolis, Minn. — ^J. F.
BiDDLE, Secretary-Treasurer,
January 28-29, 1916. — Annual Clinic of the Chicago Dental Society, Hotel La Salle, Chicago,
lU. — Percy B. D. Idler, 30 No. Michigan Ave., Secretary.
February 11-12, 1916. — ^The thirty-third Annual Meeting of the Minnesota State Dental
Association, at the University of Minnesota, Minneapolis. — Max E. Ernst, 614 Lowr>'
Bldg., St. Paul, Minn., Secretary.
February 16-18, 1916. — ^The tenth annual clinic, Manufacturers' and Dealers' Exhibit of the
Marquette University Dental Alumni Association, Milwaukee Auditorium, Milwaukee,
Wis. — V. A. Smith, Secretary.
February 21-22, 19 16. — Golden Jubilee of the Washington University Dental School, at the
Dental School, 29th and Locust Sts., St., Louis Mo.— H. M. Fisher, Metropolitan Bldg.,
Secretary.
February 23-24, 1916. — Central Pennsylvania Dental Society, Johnstown, Pa. — Chairman
Exhibit Committee, C. A. Matthews.
March 20-26, 19 16. — ^The Tri-State Post Graduate Dental Meeting (Missouri, Kansas, Okla-
homa), Kansas City, Mo. — C. L. Lawrence, Enid, Okla., Secretary.
April 4-7, 1916. — Dental Manufacturers' Club, Chicago, 111. Meeting in the Banquet
Hall, Auditorium Hotel. — Chairman Exhibit Committee^ A. C. Clark, Grand Crossing,
Chicago.
April 14-16, 1916. — ^West Vii^inia State Dental Association, Kanawha Hotel, Charleston.
May, 1916. — Indiana State Dental Association, Claypool Hotel, Indianapolis, Ind. — A. R.
Ross, Secreiary.
May 2-4, 1916. — Iowa State Dental Society, Des Moines, la. H. A. Elmquist, Des
Moines, la., Chairman of Exhibit.
June, 191 6. — Florida State Dental Society, Orlando, Fla. — M. C. Izlar, Corres. Secy.
July 11-13, 19 16. — ^Wbconsin State Dental Society Meeting, Wausau, Wis. — ^Theo. L. Gil-
bertson. Secretary.
October, 18-20, 1916. — Viiginia State Dental Association, Richmond, Va. — C. B. Gifford,
Norfolk, Va., Corresponding Secretary.
IMPORTANT POSTPONEMENT
The meeting of the National Association of Dental Faculties which was to have been held
in Minneapolis, January 28r-29, 1916, has been postponed to meet in Louisville in July, 1916.
The exact dates will be announced later.
B. Holly Smith, Chairman Ex. Com.
N. A. D. F.
Digitized by
Google
The Dental Digest
GEORGE WOOD GLAPP, D.D.S., Editor
Published monthly by The Dentists' Supply Company, Candler Bldg.,
Times Square, 220 West 42d Street, New York, U. S. A., to whom all com-
munications relative to subscriptions, advertising, etc., should be addressed.
Subscription price, including postage, $1.00 per year to all parts of the
United States, Philippines, Guam, Cuba, Porto Rico, Mexico and Hawaiian
Islands. To Canada, $1.40. To all other countries, $1.75.
Articles intended for publication and correspondence regarding the same
should be addressed Editor Dental Digest, Candler Bldg., Times Square,
220 West 42d Street, New York, N. Y.
The editor and publishers are not responsible for the views of authors ex-
pressed in these pages.
Entered as Second Class Matter, at the Post-Office at New York City.
Under the Act of Congress, March 3, 1879.
Vol. XXI 1
FEBRUARY, 1916
No. 2
TICLE3
EXPERIMENTS TO DETERMINE THE
TOXICITY OF THERAPEUTIC AGENTS
IN THE TREATMENT OF PYORRHEA
ON ANIMAL CELLS GROWN IN VITRO
By W. F. Spies, D.D.S., New York
In the therapeutic treatment of all infectious conditions and of in-
flammations, the objects sought are threefold; first, to reduce the power
of the attacking micro-organism, at least to the point of harmlessness;
second, to accomplish the object with the minimum of irritation or dis-
turbance of local tissue cells; third, to restore normal circulation of the
blood and lymph.
In previous investigations to determine the efficiency of any particular
preparation or method of treatment of such conditions, only one or two
of the objects enumerated have usually been considered. Estimations
of the germicidal efficiency of therapeutic agents have been frequently
made and recommendations for use have been based upon them, without
sufficient thought of the effect of such agents upon the tissue cells.
There have been no satisfactory laboratory methods for determining
the effects of germicides and antiseptics upon living tissues, and of re-
cording the effects so that they may be available to all. It is apparent
that the minute tissue effects of the substances employed as antiseptics
Digitized by
Google
70 THE DENTAL DIGEST
or germicides should be determined by exact laboratory methods rather
than the unorganized, individual observation upon which we have
heretofore depended.
With the successful growth of animal tissue cells outside of the body,
there came opportunities for testing the germicidal efficiency and tissue
toxicity of various therapeutic agents used in the treatment of human in-
fections. Before entering into a detailed consideration of the experi-
ments in toxicity, it may be interesting to review briefly the application
of the principles mentioned in the first paragraph to the treatment of
pyorrhea.
Pyorrhea is inflammation of the tissues surrounding the roots of the
teeth. In treating this condition, the therapeutic agents which have the
highest germicidal efficiency with minimum toxic or tissue destroying
properties should be selected. It is, of course, most desirable to destroy
or render ineffective the pathogenic or pus-producing bacteria or other
micro-organisms which may be present in a pyorrhea pocket. On the
other hand, it is important that the indolent cells lining a pyorrhea pKDckct
shall be so stimulated that they will promptly resume their normal
activities. The use of powerful irritants defeats this purpose rather than
aids it. The effect of such agents is to destroy the inflamed cells lining
the pocket, to increase the area of inflammation and to retard the process
of repair.
HISTORICAL
The later researches on the cultivation of tissue cells outside the body
were developments from the original studies by Roux on surviving cells
when isolated from the animal organism. It was here that the need for
study of cell activities brought about efforts toward the prolongation of
their life. A similar need led Harrison to further develop the method to
the end that proofs of the origin of nerve fibres might be obtained. Com-
plete isolation of the growing nerve from other tissue cells was a pre-
requisite.
The necessity for supplying nutrient material to the cells during
growth brought about the utilization of various forms of lymph and
blood plasma in the artificial cell cultures. It might be said that the
present methods are largely based upon the work done by Dr. M. T. Bur-
rows, in the Sheffield Biological Laboratory in Yale, 1910. In later re-
searches, fresh, unclotted blood plasma served as a nutrient fluid for the
cell cultures.
With the greater improvement in details of the technique made by
Carrel and Burrows, there came the final procedure, which has had a wide
application in attempts to solve a variety of problems. Thus, the meth-
ods of tissue cell cultures have been easily adapted to the study of an-
Digitized by
Google
TOXICITY OF THERAPEUTIC AGENTS IN PYORRHEA 71
atomical, pathological and physiological problems. Carrel has applied
it to the solution of problems in surgery and for estimating the various
methods of preserving tissues. Lambert and Hanes have used it for the
study of cytotoxins, while Murphy has made excellent use of the process
in efforts to solve problems in immunity in tumor growth.
It remained for those who have undertaken the investigations about
to be reported, to apply this procedure to the problems of determining
the relative toxicity of germicidal and antiseptic agents upon tissue cell
cultures. Prior to these studies, the only available laboratory procedures
for the determination of. toxicity of such products consisted in the sub-
cutaneous injections of dilutions of them into animals, particularly white
mice, the end reaction being the death or survival of the animal. This
latter procedure constituted a more or less satisfactory process for deter-
mining the massive toxic doses of the agent or preparation in question.
The results, however, constituted no satisfactory indication of the actual
toxicity of any degree of dilution. Nor could the effects upon in-
dividual cells or small groups of cells be measured. It is obvious that the
results of tests with massive doses would be entirely inappropriate for the
determination of the finer degrees of toxic action against small groups of
tissue cells, such as would be affected in the application of any therapeutic
agent in the treatment of pyorrhea.
In the development of the method of testing tissue cell toxicity by the
use of cell cultures, much time was spent in preliminary investigations.
From these investigations, a procedure which gave reasonably satisfactory
results was finally determined. The following is a description of the
technique of that method.
TECHNIQUE
The medium for growing the tissue was obtained in the following way.
The blood was collected from the jugular vein of a chicken by means of a
sterilized cannula which had been previously immersed in olive oil. The
blood was allowed to flow into a sterile thin glass test tube. Small pieces
of ice were put around the base of the test tube on the dissecting table, so
as to chill the blood immediately and prevent coagulation. When about
half full, the tube was put in a dish of ice. About eight test tubes of
blood were collected each time. As soon as possible these test tubes were
packed in ice in a centrifuge tube and centrifuged for five minutes at 2,700
revolutions per minute. The clear plasma was then drawn off with a
pipette and put in another small sterile test tube and the tube corked.
These corked tubes were kept on ice until ready for use. Plasma kept
in this way was found to produce good growth even when it was a month
old.
Digitized by
Google
72 TH£ DBNTAL DIGEST
In these tests, two parts of plasma were diluted with one part of
Ringer's solution* and a drop of this medium was put on a cover slip with
a piece of tissue and coagulation took place in a very short time. A hol-
low ground slide ringed with vaseline was then inverted over the cover
slip. The cover slip was sealed to the slide with hot paraffin. The slides
were kept in an incubator at 39° C.
The tissue for these tests was obtained from chick embryos 10-15
days old. The tissue was cut up into very small pieces under a magnify-
ing lense. Sterile black paraffin in Petri dishes was found to give a better
cutting surface than glass.
Portions of this finely divided tissue were transferred on the blade of
the scalpel to sterile watch glasses containing i cc. of sterile Ringer's
solution. These watch glasses were contained in sterile Petri dishes as a
protection.
The substances to be tested were tincture of iodine (U. S. Ph.) and
dentinol. These were diluted with Ringer's solution in the proportion
of I of dentinol or iodine to 49 of Ringer's solution written as follows:
I — 50, and in i — 100, i — 200, i — 400. The addition of i cc. of the dilu-
tion to I cc. of Ringer's solution containing the tissue gave the required
dilutions. The tissue obtained from the chick embryos was exposed to
the test substance for five minutes. It was then transferred by means of
a pipette to another Petri dish containing 15 cc. of Ringer's solution to
wash the tissue. These Petri dishes were then placed in the incubator
until ready for planting. All these operations were done in a warm room
and the solutions coming in contact with the tissue were warmed to
prevent chilling it. Also all preparations for the test were made before-
hand, so as to have the time elapsing between the cutting up of the tissue
and the planting and placing in the incubator as short as possible.
RESULTS OF A REPRESENTATIVE TEST
The material tested and the results of a representative test are given
in the table below and show the growth or non-growth of the tissue in the
different dilutions on five minutes' exposure.
— No growth
-h Growth
Dentinol 5 Minutes* Exposure
Specimen
No. I Xo. 2 No. 3
1-50 + + +
I— 100 + + +
1—200 -h -\- -f
1—400 -f -I- -f-
*Ringer's Solution is Sodium Chloride 0.7%, Calcium Chloride 0.025%, Potassium Chlor-
ide 0.03%, Distilled Water
Digitized by
Google
TO PREVENT MODEL FROM BREAKING 73
TmcTURE OF Iodine (U. S. Ph.) 5 Minutes' Exposure
Specimen
No. I No. 2 No. 3
1—50 + "~ ~
I — 100 — + —
I — 200 + + —
1—400 -f + +
CONTROL
Tissue not treated + -f +
The results indicate that under these conditions, a dilution of den-
tinol I in 50, is as free from toxic action as a dilution of iodine i in 400.
SUMMARY
A study of the literature on tissue cultivation and the results of the
foregoing tests bring out several very important points:
1. The primary object in growing tissue outside of the animal body
is that it may be microscopically observed in the living condition.
2. Interesting observations on cell division and many other problems
are better studied by using the method of tissue cultivation.
3. The culture methods offer a promising means for the study of the
response of cells to directive stimuli.
4. That wound healing could be imitated in culture.
5. A satisfactory method has been developed for the comparative
estimation of the toxic effects of antiseptic and germicidal agents upon
tissue cells by the use of the cell culture method.
6. In the treatment of pyorrhea the therapeutic agents which have
the highest germicidal efficiency with minimum toxic or tissue destroying
prof)erties should be selected.
BIBLIOGRAPHY
1. Roux — Virchow's Archiv. Bd. 114 — 1888.
2. Harrison — ^Trans. Cong, of Am. P. & S., Vol. IX, 1913.
3. Burrows — ^Trans. Cong, of Am. P. & S., Vol. IX, 1913.
4. Carrel and Burrows — ^Joum. Exp. Med., 191 1 — xiii.
5. Carrel and Burrows — Joum. Exp. Med., 1911 — xiv.
6. Carrel— Joum. Exp. Med.— Vol. XVIII— 1913.
7. Burrows — ^Joum. Am. Med. Ass*n., 1910 — Iv.
8. Carrel — ^Joum. Am. Med. Ass'n., 191 2 — lix.
9. Lambert and Hanes — Joum. Exp. Med., 1911 — xiv.
10. Murphy — ^Journ. Am. Med. Ass*n., 19 13 — xvii.
TO PREVENT MODEL FROM BREAKING
Most plate makers, occasionally break model of lower case, at
angle, in separating flask preparatory to removing wax. This will be
avoided by prying flask apart in front (at toe) instead of in the back
(or heel). The action is like a hinge and naturally unhooks model.
Will S. Kelly, D.D.S., Wilkes-Barre, Pa.
Digitized by
Google
74 TH£ DENTAL DIGEST
CLOSED MOUTH IMPRESSIONS*
By Samuel G. Supplee, New York, N. Y.
second paper
diagnosis of the conditions in the mouth
It is very important to diagnose conditions in the mouth very care-
fully before starting to take your impression, for facts gained in this
examination will be of great value to you in fitting your tray, taking the
bite and finishing the plate as well as allowing for the settling of the
denture.
In view of the fact that it is desirable to retain the upper denture
principally by means of adhesion by contact, it naturally follows that the
larger the area covered by the plate, the greater will be the retentive
power. The smaller the mouth, the more difficult it is to secure the
desired retention.
THE AREA OF THE PLATE
In examining the mouth it is important that we shall plan to make
the plate cover as much area as the existing conditions will permit.
This applies particularly to the length of the plate, antero-posterially.
When the ridge is hard in front, the plate can extend to the edge of the
vibrating portion of the soft palate.
When the ridge is soft in front, it must extend beyond the hard palate
far enough so that the edge of the plate may press upon the soft palate
and embed itself sufficiently to compensate for the amount the soft ridge
will give when pressure is brought to bear on the front teeth.
By the old method of plate work, we should be limited in extending a
plate back as far as desirable owing to nausea, but by observing the
principles outlined this difficulty is eliminated.
POINTS FOR DIAGNOSIS
Every mouth should be examined in the following respects:
The character and extent of soft and hard tissues overlying the hard
palate. Several pounds' pressure should be exerted with the tip of the
finger to disclose any hard bone hidden under the mucous membrane,
that proper relief can be placed on the model to allow for the settling of
the denture. It is surprising how many hundred plates are failures due
to lack of the proper relief in the median line which Dr. Haskell called
particular attention to many years ago.
*This article began in the January 191 6 issue.
Digitized by V:iOOQIC
CLOSED MOUTH IMPRESSIONS
75
Where the vibrating portion of the soft palate begins.
The character and extent of soft tissue if in the region of the ridges.
The location and strength of the muscular attachments on the buccal
and labial border of the upper ridge and both sides of the lower ridge.
The space between the tuberosities of the upper ridge and the coronoid
process and rami when the mouth is opened and closed.
METHODS OF DIAGNOSIS
Examinations should be made with the index finger with the mouth
open and closed.
All unusual conditions should be recorded on a chart. They will aid
in making the dentures or in satisfying the patient.
The chart used at the Gysi school of articulation is reproduced on
this page. It foUows very closely Dr. McLeran's design.
Chart for Arti6cial Dentures (After that compiled by Dr. McLeran, Omaha, Neb.)
In making this diagnosis it is advisable never to look into the mouth
until you have made a careful examination with the index finger wh^e
having the patient open and close a number of times. By using the
point of the finger as a measuring instrument, you are able to get a very
complete idea of the possible height of the rim of the proposed plate.
By using heavy pressure with the index finger, you can determine the
depth and area of the movable tissue overlying the rear half of the hard
palate, and the conditions of the ridge in the region of the eight front
Digitized by
Google
76 THE DENTAL DIGEST
teeth. This should guide you as to the length of the plate antero-
posterially.
The knowledge of these conditions will be of great value to you in
case you should have trouble in securing the desired results.
HIGH AND LOW RIMS
The height of the rim will be determined by the range of movements of
the attachments when the mouth is open and closed. If the action is
short and strong, your rim should be low. If long and weak, your rim
should be high.
VULCANITE AND METAL PLATES
If the entire vault and ridges are extremely hard and flat and the
muscles attached close to the crest of the ridge, it is advisable to make a
rubber plate for the patient to wear at least a year or so until the action
of rubber causes the tissues to become softer, at which time a metal plate
can be made with better results.
If the mouth has a tendency to soft ridges and an excess amount of
soft tissue in the vault, it is wise to advise the patient to have a metal
plate.
A temporary gold lined plate should be made for the patient to wear
for a year to partially reduce the inflammation before making the metal
plate.
If the patient is limited in means, very good results can be secured by
refitting the old rubber plate and lining it with foil gold as a temporary
plate for six months, to reduce the inflammation before making a gold or
metal plate.
If the old rubber plate fits fairly well, place a gold lining in it without
changing, as the shrinkage of the rubber plus the thickness of the lining
will improve the fit sufficiently to last till the inflammation from the
rubber is materially reduced before making a metal plate.
It is very unfortunate that so few dentists spend the necessary time
to induce the patients to have metal plates.
From general observation the one great reason for this has been that
they could not be so sure of securing a well-fi.tting denture.
There are three principal causes for this existing condition:
First, so little attention has been given to essentials of an impression
that comparatively few plates would be a success were it not for the fact
that the inflammation created by the rubber in contact with the tissue
will compensate for the deficiencies.
Second, most metal plates are made for patients after they have been
wearing either a temporary rubber plate, or because the mouth has been
inflamed by wearing a rubber plate too long.
Digitized by V:iOOQIC
CLOSED MOUTH IMPRESSIONS 77
If a well fitting gold plate is placed in a mouth of this kind, it is only
a short time when the inflammation is materially reduced and the plate
does not fit.
As the gold plates have been made from the same imperfect impres-
sions as rubber, and the fit was no better to start with, they certainly
have a decided disadvantage as they have a tendency to reduce inflamma-
tion rather than to cause it.
Third, most gold plates have been swaged of metal heavier than 28
gauge and it is very difiicult to make this material conform to the minute
details of the model.
There are many ways in which these difficulties can be overcome, and
they will be outlined more fully in a, chapter on metal plates.
There are recent improvements by which we can cast and condense
an aluminum plate from an artificial stone model and then eliminate the
contraction by using a putty or shot swage to drive it to an accurate fit
and incidentally further condense the metal.
The triple refined aluminum which can now be secured has prac-
tically eliminated all the former troubles of distintegration.
In this way we are able to eliminate many of the difficulties due to
the expansion and shrinkage of rubber and make a cheap durable plate
which on the whole is far superior to rubber.
HISTORY OF THE CASE
It is well to go into the history of the case in hand before promising
the patient quick and positive results, for the question of muscle strain
and muscular development will play a prominent part in view of the
fact that we are going to use the muscles indirectly to hold our plates in
their proper position.
GRADUAL DEVELOPMENTS
If the patient has been masticating for a number of years on a few
miscellaneous teeth with the jaw abnormally closed, or masticating on
one side only, or gone without teeth entirely, we cannot expect to open
the bite and place the jaws in their correct position and expect them
to be fully efficient and remain in the same corelation after the muscles
have been fully developed in their new position.
This development should be accomplished in stages if we are to
expect to pve our patient the comfortable use of the plates during the
development period. I shall attempt to deal with this subject in the
chapter on ** Muscle and Tissue Development."
The ignorance of this subject has been the cause of considerable loss
in the average dental practice, as many dentists have made two or more
sets of plates for patients, carrying them through this development stage
Digitized by
Google
78 THE DEHTAL DIGEST
without knowing it, before securing permanent results, yet have received
only one fee and have wound up with a dissatisfied patient, complaining
because the plates were not made right the first time.
If conditions had been properly understood, arrangements could have
been made for the patient to have comfort during the development stage,
and pay for the dentures necessary to accomplish the desired results.
This article is expected to be continued.
SHORTAGE OF DENTAL PRACTITIONERS
The institution of a diploma in dental surgery took place compara-
tively recently in this country. The result is that the number of qualified
dentists is far short of the requirements of the population, and that a large
number of unqualified men practice. They are not prevented from doing
this, but they must not call themselves dentists. This is a very small
drawback, as they can exhibit sets of teeth and call themselves "tooth
specialists." At a meeting of the General Medical Council, Mr. Tomes,
chairman of the Dental Education and Examination Committee, sub-
mitted a report on the shortage of dentists. Communications had been
made with the various licensing bodies for the possibility or curtailment
of the curriculum without lowering the standard of dental practice.
Some of the bodies questioned the existence of any shortage, pointing out
that many qualified men are not fully occupied, the public being uncon-
vinced of their advantage over the unqualified. Attention was also
drawn to the lowering of the social status which arose from the intrusion
of great numbers of unqualified persons, and to the fact that business
men who had acquainted themselves with the existing state of things
often considered that from a business point of view qualification was
worthless or even a hindrance, and so did not put their sons at dental
schools. The Incorporated Dental Hospital of Ireland alone considered
the possibility that the simpler dental requirements sought by the poorer
classes might perhaps be met by a lower grade of practitioner, though
this was also suggested in one of several letters sent by private prac-
titioners. The main conclusion was that no appreciable increase in the
members of the dental profession can be looked for until the law gives
further protection to the qualified man against the unqualified. A very
insidious form of deception was pointed out. An unqualified man dare
not put on his plate "dental surgeon," as this would render him liable to
prosecution. This is avoided by putting beneath his name "dental
surgery," which can be done with impunity.— /t^ttrwa/ American
Medical Association,
Digitized by
Google
WESTERN ATTITUDE TO ANATOMICAL ARTICULATION 70
A TRIP REGISTERING THE WESTERN ATTITUDE TO
ANATOMICAL ARTICULATION
By Dayton Dunbar Cabipbell, D.D.S., Kansas City, Mo.
While in Kansas City conducting a class in Conductive Anesthesia,
Dr. Arthur E. Smith of Cleveland suggested the trip. Having learned
that I was to be one of the essayists of the Montana State Dental Asso-
ciation in July and that I planned to be at the Panama-Pacific Dental
Congress in September, he said, "why not teach the Gysi method of
Anatomical Articulation during the interval?"
Acting upon this suggestion, a small, strong, trunk was packed with
dental materials, and appurtenances not readily found in every city,
Gysi Adaptable Articulator, a steropticon, Spencers Plaster Compound,
SoreFs Cement, pure aluminum ingots, nearly two hundred and fifty
lantern slides, etc.
At the meeting in Helena I constructed a full upper and lower set
of dentures upon vulcanite bases for one of the oldest members of the
Montana State Association. The Gysi Adaptable Articulator and
Trubyte teeth were used. Trubyte teeth were employed in every case
throughout the trip.
The following Monday found me in Spokane, Wash., where I brought
to Mr. R. A. Monro's attention some of the results of my efforts in
Anatomical Articulation (I carried exhibits on four Simplex Articulators).
Dr. Munro's interest secured an audience of about fifty dentists that
Monday evening. The lantern lecture, the clinical material, and a free
and informal discussion, made possible a very pleasant evening. At the
close of the session, an opportunity was afforded those interested to
join a class in Anatomical Articulation.
On account of such brief notice, many who expressed a desire to join
these classes, were unable to arrange their professional engagements, so
as to avail themselves of the opportunity.
It might be well to interpolate here that the writer was not idle while
the classes were not in session. The most enjoyable part of my trip
was spent in the various oflSces of these men assisting with difficult cases.
Dr. R. I. Vandewall, of Seattle and Dr. Leland D. Jones of San Diego
each had a case in which the patient presented a mouth with soft flabby
ridges in the region extending from I'.uspid to bicuspid. This tissue
was injected with a local anesthetic and \ :*.th a pair of heavy gum scissors,
cut away bodily. Such treatment leaves the part, after a period of two
of two or three weeks, in a condition to receive a denture that will be
permanent and eminently satisfactory.
Digitized by
Google
80 THE DENTAL DIGEST
Dr. Francis R. Fisk secured a large, well lighted room in the Old
National Bank Building where we met every afternoon for four days.
Two full upper and lower sets of dentures were made for different pa-
tients, one upon the Gysi Adaptable Articulator and the other upon the
Gysi Simplex using the face bow, by the double vulcanization process;
the other, a cast aluminum base for the upper and lower vulcanite. The
evening of July 26th was spent before a called meeting of the Seattle
Dental Society. Here we had the pleasure of renewing our acquaintance
with Dr. C. J. Stansbery and that of meeting Dr. Frank W. Hergert
who were members of the second Gysi class in Anatomical Articulation.
Dr. Leo M. Trowbridge an upper classman of my college days gave us a
splendid impression of the city and its boulevards and contributed largely
to the enjoyment of our stay. Through the kindly assistance volun-
teered by Dr. Hergert and Dr. Stansbery, the Seattle class was organized
without any particular effort on my part. The writer felt not a little
complimented with the regular attendance of these two men, who were as
familiar with the Gysi methods as the writer himself.
Although I have traveled somewhat extensively during my short
career as a dentist, I have never visited in any other city where there
were so many well lighted and cleanly kept offices, neatly gowned
assistants, and broad, open minded dentists, as I found in Seattle.
The course in Seattle was started with a lecture on the 26th but was
not completed until the following week.
In the meantime I visited Vancouver, British Columbia, to lecture
before the Vancouver Dental Society on Tuesday evening. Here one
of my Gysi classmates, Dr. W. H. Thompson, rendered indispensable
assistance in organizing the class. Here could be seen at any time, sol-
diers in uniform getting ready to ship for the war. Great difficulty was
experienced in passing my lantern slides through the customs. Prac-
tically no attention was given to the rest of my paraphernalia.
Through the courtesy of Mr. J. W. Henderson, manager of The
Temple-Pattison Co., a room adjoining their dental depot was secured.
It was from Mr. Basil Bayne of the Bayne Bros. Dental Laboratory that
we learned to xnilcanize gold-dust rubber in the spoon end of a wax
spatula by heating slowly and until it became fluid. By this method a
tooth may be attached to a plate in five minutes where otherwise it
would take an hour and a half. Other rubbers cannojt be used since they
contain no aluminum; the heat conducting element is essential.
Some of the dentists in this class were so enthusiastic with this work
that they wrote to their confreres, in Victoria suggesting that they
organize a similar class. In the meantime I returned to Seattle and
proceeded with the work there.
Digitized by
Google
WESTERN ATTITUDE TO ANATOMICAL ARTICULATION 81
There were thirteen bonafide members to the Victoria class including
Dr. Knight who does not appear in the picture, together with each man's
student assistant. These students acting as apprentices are thereby
fulfilling some of the dental requirements of the Dominion. This class
was held in the Garesche Building adjacent to the offices of Dr. A. J.
Garesche whose services and courtesies were much appreciated. Dr.
H. LeRoy Burgess was a former classmate of mine in the Kansas City
Dental College. Our hair-raising drive over Mt. Malahat in his power-
ful McLaughlin on high speed, and our little dinner at the beach with
the other members of the class, will not soon be forgotten.
The classes in Portland, San Diego, Salt Lake City, and Denver
were held from four to six in the afternoon and from seven to ten in the
evening. We regret that these hours together with the rush of work,
necessarily eliminated the photographer.
Those in the Portland class were Dr. Treve Jones, Dr. W. C. Adams,
Dr. Chapin F. Laudervale, Benj. E. Gulick, and Dr. Clyde Mount of
Oregon City. It was here that I had the pleasure of discussing Dr. J.
Leon Williams' book on "A New Classification of Artificial Teeth."
While the Panama-Pacific Congress was not as large as some other
dental meetings previously attended, every clinic and every lecture was
well attended and several of these were, by request, repeated. This
was particularly true of Dr. C. J. R. Engstrom's motion pictures showing
Digitized by
Google
82
TH£ DENTAL DIGEST
the use of the Gysi Adaptable Articulator. Here we had the
pleasure of serving as a clinician in Dr. Frank W. Hergert's section, on
**The Gysi Methods of Anatomical Articulation."
The men specially interested in Prosthetic procedure quite naturally
became well acquainted with each other in discussing the relative merits
of the Greene Method of Impression taking and the new Hall method of
perfected plaster impressions. Dr. Rupert E. Hall of Houston, Texas,
Front Row, left to right: Dr. F. J. Lenz; Dr. G. J. Whitfield; Patient; Dr. C. J. Stans-
bery; Dr. D. D. Campbell; Dr. F. W. Hergert; Miss Moore; Dr. C. H. Wharton
Back Row, left to right: Dr. D. W. Bennett; Dr. N. H. Smith; Dr. W. S. Padget; Dr.
L. M. Trowbridge; Dr. W. L. Harrison; Dr. R. I. Vandewall; Dr. E S. Sweeney; Dr. C.R.
Oman; Dr. H. W. Appleby; Dr. L. E. A. Hooey; Dr. E. B. Edgers; Dr. B. S. McCord
maintained that no material which offers resistance to the tissues was
suitable for taking impressions, and claimed that the apparent success of
the Greene method, was due to the fact that its use produced a vacuum
over the entire maxillary surface or intaglio of the impression save on the
periphery or the well massaged borders and post-dammed palate. This
small vacuum over the entire surface of the impression, constitutes an
element of unconscious deception, deceiving not only the patient but
also the dentist himself. The vast majority of those questioned by the
writer, admitted that they had never constructed a denture that fitted so
Digitized by V:iOOQIC
WESTERN ATTITUDE TO ANATOMICAL ARTICULATION
83
tightly and snugly after a few days' time as the tested compound im-
pression.
I should like to mention here one lesson that I have learned thoroughly,
viz. ; that no patient should be given a demonstration tending to show
how very satisfactorily his completed denture will be retained — rather,
that more stress should be laid upon the personal equation represented in
the patient. The patient should learn that successful dentures are pro-
Front Row, left to right: Dr. G. Dier; Dr. W. F. Fraser; Dr. A. J. Garesche; Dr. D. D.
Campbell; Dr. Lewis Hall; Dr. A. H. Tanner
Back Row, left to right: Dr. S. G. Clemence; Mr. J. Crossan; Dr. H. H. Hare; Dr. H.
LeRoy Burgess; Dr. E. H. Griffith; Dr. Alf. J. Thomas; Dr. H. J. Henderson
duced through two equal factors; constructive on the part of the operator
and adaptive on the part of the one operated on.
The San Diego class composed of Drs. H. C. Collins, Leland D. Jones,
Chas. G. Giddings, W. E. Allen, L. A. Viersen, J. L. Ross, W. Harmon
Hall, F. J. Holt, L. G. Jones, Emma T. Reed, Kent Kerch and the
following laboratory men: Drs. Alexander Swab, Frank V. Clayton, S.
A. King, was held in the American National Bank Building. The class
work here, in Salt Lake and in Denver, differed from that of the other
cities in this respect, that instead of using the Gysi ^^ Simplex'' Articula-
tor, the new Hall was substituted. Two full upper and lower dentures
Digitized by
Google
84
THE DENTAL DIGEST
were made for our patient upon the Gysi Adaptable and the Hall Articula-
tor. In this manner the class was enabled to compare the relative merits
of each. One of the special features of this class was the construction of
two casts, pure aluminum bases, one being swaged upon the original
Spence's cast (after having been polished), to correct the contraction due
to the physical properties of the aluminum; the other being inserted with-
out this precaution. Needless to say, the base which was not swaged
was in no sense a perfect adaptation.
Upon our arrival at Salt Lake City, we found the dentists in a very
receptive mood, due to the efforts of Dr. Fred W. Meakin and my former
First Row, left to right: Dr. T. R. Peden; Dr. J. E. Black
Second Row, left to right: Dr. W. R. Spencer; Dr. Wm. H. Thompson; Dr. D. D.
Campbell; Dr. R. L. Coldwell; Dr. P. D. MacSween
Third Row, left to right: Grant (Patient); Dr. T. W. Snipes; Dr. Basil Bayne; Dr. H.
T. Minogue; Dr. S. C. E. Muirhead; Dr. H. E. Thomas; Dr. J. W. Henderson; Dr. F. Pol-
lock; Dr. R. S. Hanna
classmate Dr. Arthur C. Wherry. A class was soon organized with the
following additional members, Drs. R. L. Folsom, A. C. Gartman, W. A.
Marshall, Hyrum Bergstrom, R. E. Wight, Geo. F. Richards, Jr., C,
W. Bird.
Digitized by V:iOOQIC
INFORMATION FROM THE DENTAL PROTECTIVE ASSOCUTION 85
Dr. R. E. Wight, in an unguarded moment, told us we did not know
how to mix plaster and proceeded to prove his contention. The method
is as follows:
Place the desired quantity of plaster in a dry plaster bowl and instead
of letting water from the faucet run into it, completely submerge the bowl
and its contents. Set aside and watch until the bubbles cease to rise,
pour off the excess of water and the mix is correct. To further demon-
strate that the affinity of the plaster for water has been satisfied, and that
there is no expansion, pour the mix into a two ounce glass beaker, the
mix being perfect, the beaker will crack. Try it your way.
The last class was held in Denver with the following members en-
rolled: Drs. A. Clay Withers, Kent K. Cross, Anna M. Buell, V. Clyde
Smedley, J. Larkin Howell, Ezra E. Schaefer, Richard C. Hughes.
This class formed a Campbell Study Club and has had two meetings
since my departure. Reports of these meetings are sent to me with ques-
tions along Prosthetic lines. These are answered and suggestions made
and work outlined for the ensuing month.
In all of the classes when discussing the new classification of teeth,
stress was laid upon the manner in which teeth should be selected for
individual requirements. Plane and autochrome lantern slides were
effectively employed to show how in that much neglected field of Es-
thetics and Contour, the best results may be obtained.
The writer *s judgment, based upon the general responsiveness with
which the courses met, is that the dentists who thrive in the midst of
competition, realize that they must master some method of Anatomical
Articulation.
729 Shukert Bldg.
IMPORTANT INFORMATION FROM THE DENTAL PROTECTIVE
ASSOCIATION OF THE UNITED STATES
At the Annual Meeting of the Dental Protective Association of the
United States, held at the Hotel La Salle in the city of Chicago, on Mon-
day, December 20, 1915, the Secretary was requested to prepare a plain
statement for publication in the different dental Journals, giving such
facts as would be of general interest to the profession, and setting forth
the status of the members of the Association with reference to the pending
Taggart litigation.
NEW LIST OF MEMBERS IN GOOD STANDING
During the past year the Board of Directors revised the list of mem-
bers, eliminating from the new mailing list the names of those who were
Digitized by
Google
86 THE DENTAL DIGEST
known to be dead, out of practice, or who did not pay the assessment
levied in about 1898. On December 10, 191S1 the latter were notified
and given an opportunity to place themselves in good standing in the
Association by paying the $10 assessment. A few took advantage of
this and remitted the amount; those who did not do so were dropped
from the list.
NEXT TO THE LARGEST DENTAL ORGANIZATION IN THE WORLD
The new list of members in good standing now contains the names of
8,050 practicing dentists. These members are scattered geographically.
A glance at the list would seem to reveal the fact that almost every town
and city in the United States has one or more representatives in the
Association. With the one exception of the re-organized National
Dental Association, the Dental Protective Association of the United
States is the largest Dental Organization in the world; and the best
feature of all is that the total assets, as reported by the Treasurer at the
last Annual Meeting, amount to $35,508.37. Of this amount $26,000
is invested in approved municipal bonds; $6,000 is in individual notes
secured by a corporation note for three times the amount; and the
balance is in ready cash in a checking and savings account in the North-
ern Trust Company of Chicago. Thus it will be seen that the Dental
Protective Association of the United States is a live, healthy organiza-
tion, standing ready, as it has always done in the past, to defend its
members against the unjust demands of patentees whose claims are
worthless.
THE association's AGREEMENT WITH DOCTOR W. H. TAGGART
This brings us to a discussion of the status of our members with
reference to the Taggart litigation. On December 5, 1910, the Board of
Directors of the Dental Protective Association of the United States
recognizing the value of the Taggart Method of Casting, after much
discussion and many conferences, entered into an agreement with Doctor
W. H. Taggart, a member of the Association in good standing and the sole
owner of certain patents on this new and original method of making
dental inlays and the like, by the terms of which members of the Associa-
tion could obtain the permission to practice the Taggart Method of
Casting for the life-time of the patents (seventeen years) with any ma-
chine he may then be using for the cash sum of $15. This agreement also
provided that any member of the profession who joined the Association
within the time specified could procure such permission on the same terms.
The time limit of this agreement expired, except for recent graduates,
on February 9, 1913.
Digitized by
Google
INFORMATION FROM THE DENTAL PROTECTIVE ASSOCIATION 87
STATUS OF RECENT GRADUATES
A clause in the agreement provided as follows: '^That those who
entered the profession within one year from the date of the first court
decision sustaining the validity of patents heretofore mentioned shall
pay $15 for the permission to practice the Taggart Method of Casting;
those that enter the profession from year to year thereafter shall have
the fee reduced by as many dollars as the number of years elapsed since
the first court decision sustaining the validity of said patents. One year
from the date of graduating or entrance into the profession, in all cases,
shall be given in which to pay the stipulated fee." The phrase "en-
trance into the profession" has been interpreted by the Attorney for
the Association as meaning that an individual enters the profession when
he takes the State Board examination, receives his license to practice
and has it recorded, whether he actually begins practice at the time or
not. This explanation is here given for the benefit of the many recent
graduates who are desirous of information regarding their standing under
the terms of the Association's agreement with Doctor Taggart.
OWNERSHIP OF A TAGGART MACHINE CARRIES WITH IT THE PERMISSION
TO USE THE METHOD
During the time from December 5, 19 10 to February 9, 19 13, when
the terms of the agreement were open to not only our members, but to
the entire profession, there were over 4,200 practicing dentists who
availed themselves of the terms and paid the $15. At this time Doctor
Taggart was offering- his casting machine for sale. This could be pur-
chased through the Association for $75 cash, or direct for $100 cash. A
great many of our members purchased the machine direct from Doctor
Taggart before the agreement was made; a few subsequently purchased
it through the Association. A considerable number of dentists, who were
not members of the Association, also purchased the machine direct.
The right to use the Taggart Method of Casting went with the purchase
of a machine from whatever source; and the ownership of a machine
to-day carries with it the permission to use the Method. This informa-
tion is given and emphasized here for the benefit of those dentists who
own a Taggart Casting Machine. Those of our members who purchased
the machine must remember that whoever owns the machine to-day, no
matter where or how it was purchased, holds the sole right to use the
Method. In other words a machine cannot be sold to another and the
former owner retain the privilege of using the Method.
STATUS OF MEMBERS IN TAGGART LITIGATION
This question is frequently asked: Where does the individual stand,
with reference to the pending Taggart litigation, who is a member of
Digitized by
Google
88 THE DENTAL DIGEST
this Association in good standing and who did not accept the terms of the
agreement with Doctor Taggart before the time limit expired? In reply
to this important question, we will say that every member was notified
individually and through the Dental Journals, not only once but several
times, of the opportunity afforded by the terms of the agreement; and
those who did not Siccept forfeiled their right to protection, from this source
by this Association, They are hereby so notified that they may either
settle direct with Doctor Taggart or make whatever other arrangements
they see fit to protect themselves from the Taggart patents.
The question has also been raised as to the right of a member of this
Association, who did accept the terms of the agreement with Doctor
Taggart, to join other Associations organized primarily to fight Doctor
Taggart. Every member of the Dental Protective Association of the
United States who accepted the $15 proposition, agreed by signing the
by-laws, to abide by the same. Under Section XIII of said by-laws, the
third paragraph reads as follows: "If said $15 be paid before the entry
of any decree or judgment finding any of Doctor Taggart's patents men-
tioned above in said agreement valid or granting damages for infringe-
ment thereof, the member is free to practice the Method with any machine
he may then be using, and after the date of said decree or judgment, the
member is not to purchase or use machines infringing Doctor Taggart's
machine patents, except as aforesaid, and no member of the Association is
to defend or join in or contribute to the defense of any suit upon any of said
patents while practicing the Method under such permission from Doctor
Taggart,'' In this connection it may be stated that this agreement
with Doctor Taggart was no voluntary effort on his part; and after he
finally consented to what he felt was practically giving the method away
($15 for 17 years amounts to about 88 cents a year) he demanded this
clause on the contention that he would not grant a man the right to use
the Method for practically nothing and leave him free to contribute
several times the amount, if he so desired, to defeat him in court of his
just due. The Board of Directors recognized the justice of this demand
and consented to it. Thus this question is answered here in full.
MAY DENTISTS NOW JOIN THIS ASSOCIATION?
It is frequently asked if the doors of the Dental Protective Association
of the United States are now closed to the profession, or if members of the
profession may join at this time. In reply to this question we will say
that, subject to the approval of the Board of Directors any member of
the Dental Profession may become a member of the Association on pay-
ment to the Treasurer of a membership fee of $10, and subscribing to the
by-laws of the Association; but it must be with the distinct understand-
Digitized by V:iOOQIC
INFORMATION FROM THE DENTAL PROTECTIVE ASSOCIATION 89
ing that the time limit of the agreement with Doctor Taggart has expired,
except, as previously mentioned, for recent graduates or those who have
not been in the practice of dentistry for more than one year.
WHY DENTISTS ARE JOINING AT THIS TIME
Though no immunity can be offered by this Association at this time
from Doctor Taggart, except to recent graduates; nevertheless, dentists
are joining the Association for the protection afforded from other sources.
There has scarcely been a time since 1888, when the Dental Protective
Association of the United States was first organized, when the Association
has not had pending more or less patent litigation. It has been success-
ful in all of its suits to date. There must be a reason for this. We believe
it is due to the fact that the Association was organized on the right basis;
for the sole purpose of defending its members against abuse by patentees
whose claims were worthless, and not to defraud any man of his just due.
The United States Government, through its patent ofl5ce, grants patents
to individuals whom it believes have something worthy, new, and original.
In this manner it encourages inventive genius. It would be wrong for
any Association to attempt to fight all patents, dental or otherwise,
regardless of their merit. Such is not the policy of the Dental Protective
Association of the United States; but let it be remembered, thai it
stands to-day^ as it has stood for nearly twenty-eight years j like a stone wall
between its members and patent abuse.
At the present time the Association is defending one of its members
who has been sued for infringing a patent on a set of instruments for
scaling teeth. In the opinion of the Board of Directors the principle
involved in the patent, and on which it is based, is neither new nor
original; and they felt that it would be dangerous for the members and
the profession to have said patent validated in court. Therefore, they
have directed the attorney to assume full defense of the suit on behalf of
the Association.
In this brief article we have endeavored to cover and explain, so far
as possible, all points which may arise now that the Taggart and other
litigation is pending, in order to thoroughly inform the membership of
the Association, and incidentally others in the profession who may be
interested; and to avoid unnecessary correspondence. However, should
anyone want further information or desire to join the Association, they
may address the Secretary, 39 South State Street, Chicago, 111.
Byorderof the Board of Directors: J. G. Reed, President.
J. P. Buckley, V.-Pres. & Sec'y.
D. M. Gallie, Treasurer.
Chicago, January 4, 1916.
Digitized by
Google
DEDICATION OF THE MILLER MEMORIAL MONUMENT
The Ohio State Dental Society Meeting for 191 5 was one of
especial interest as it was the scene of the Dedication of the
Miller Memorial Statue, a monument raised by the united
eflforts of the dental societies of Ohio, though nearly every state
contributed to this monument. The statue is situated near the
library building, on the campus of the Ohio State University.
The memorial was unveiled by Miss Annie Brooks, of Alex-
andria, Ohio. The assembly afterward gathered in the chapel
of the university where an address was delivered by Dr. E. C.
Kirk, Philadelphia; remarks were also made by Dr. T. W.
Brophy, Chicago; Dr. N. S. Hoff, Ann Arbor; Dr. Thos. P.
Hinman, Atlanta; Prof. G. W. Knight, of the Ohio State
University and by others.
Dr. Miller was born August i, 1853 near Alexandria, Ohio.
He entered the University of Michigan the fall of 1871 and took
his degree of Bachelor of Arts June, 1875. Deciding to adopt
as his profession that of mathematical physics — he went to
Scotland and studied in the Edinburgh University under Sir
William Thomson. His health failing him through over-work,
he sought rest, and it was during this period of recuperation that
he met in Berlin, Dr. F. P. Abbot, who was the representative
American dentist in that city. It was through Dr. Abbot's
influence that he decided to return to America and take the
dental course, graduating from the University of Pennsylvania
in 1879.
Later he was called to accept the office of Dean of the
Dental Department of the University of Michigan.
He practised abroad extensively as well as wrote volumin-
ously, being the author of over one hundred books, and articles
on every phase of dentistry.
A year previous to his death, Kaiser Wilhelm had conferred
upon him the rank of priv>'^ medical councilor.
Digitized by
Google
STATUE OF DR. WILLOUGHY DAYTON MILLER
Born, August i, 1853. Died, July 27, 1907
Digitized by V^OO^ Ikl
92 THE DENTAL DIGEST
CORRESPONDENCE
Editor Dental Digest:
(In answer to L. B. Brown October Digest, page 632). If Cookville,
Tenn., is as hot a place as some parts of Australia, it is quite possible
that the worm arrived in that tooth per medium of a blow fly.
Some years ago I was practicing in a town that was very hot and where
the above fly was a pest. One day I had extracted a tooth and laid it
down while I did something else, probably to console the patient. I was
young at the time and perhaps nervous, but my astonishment was great
when on going to remove the tooth out of sight I saw a worm in the
cavity and one on the root.
For days I began to wonder if the gentleman was right who traveled
selling pills that you " simply placed in your decayed tooth which removed
the worm that caused decay and toothache.''
It was sometime before I thought of the above explanation.
I am yours sincerely,
J. Kempthorne,
Atherton, Marrickville, N. S. W., Australia.
ANSWER TO G. F. LOGAN, D.D.S.*
Books on pathology and surgery recognize two causes of disease,
namely, predisposing and exciting. Dr. Logan recognizes only one,
therefore he is wrong. {See Items of Interest^ December, 1915).
Dr. Logan states that we all know that tartar is not the cause of
pyorrhea. Now I have never seen a case of pyorrhea where tartar was
not present or had been present long enough to cause the pyorrhea; but
some dentists do not find it and therefore say it is not present.
I have a patient who had been treated for pyorrhea and at the last
visit he made to his former dentist, he told the patient he did not have
any tartar on his teeth; two days after the last visit to his former den-
tist he applied to me for treatment and I found sanguinary tartar (hard
brown tartar) under the gum on ten or eleven of his teeth. If pyorrhea
is caused by tartar, tartar must be the cause of pyorrhea.
If tartar is not the cause what is the use of removing the tartar to
cure the pyorrhea or before curing pyorrhea why not cure the pyorrhea
then remove the tartar? It is not ix)ssible. I have never seen a case
of pyorrhea alleviated to any extent or cured where tartar was present,
and that should be proof enough that tartar is the cause of pyorrhea.
Tartar is the cause of expulsive gingivitis. I do not like the word
•Items of Interest, Dec., 1915.
Digitized by V:iOOQIC
CORRESPONDENCE 93
pyorrhea as it is generally used, as expulsive gingivitis is a better term.
Many dentists use the word pyorrhea whether pus is present or not.
Now I believe pus must be present to use the word pyorrhea properly.
C. Wayne Mingle, D.D.S.,
December 26, 1915 731 W. Erie Ave., Philadelphia, Pa.
Editor Dental Digest:
I should like to inquire of you through the Digest, what foundation,
in fact, there is for the current rumor that conductive anesthesia of the
mandible is apt to result in permanent anesthesia of some of the parts.
I am perfectly familiar with the answer that Thoma and Fischer give
to this question, but somehow I keep hearing of dentists who have heard
that a friend of a friend's friend had such a case.
Do you suppose that such rumors have been passed along by dentists
who did not possess the skill or the nerve to employ conductive
anesthesia?
Do you think that sufficient time has elapsed since the introduction
of this method to make the judgment of Thoma and Fischer absolutely
authoritative and final on this point?
Yours very truly,
A.
Editor Dental Digest:
On page 8 of the January Digest the question is asked, *'What is
the best thing to do for a child three years old who breathes through the
mouth nights and snores as loud as an adult? W. B. B."
Ttike two strips of surgeon's plaster, f in. wide and i in. long, have
her turn the lips in, close the mouth tight, stick the two strips on each
side of centre, sealing the mouth tight so she will breathe through the
nose. In the morning take hold of one comer and pull the plaster off.
This metliod continued nights for several years will form the habit of
correct breathing and prevent the cHld from having colds every few
days. Nine tenths of the colds children have can be prevented by this
process. The child will sleep better and enjoy better general health.
Levi C. Taylor,
Hartford, Conn.
Editor Dental Digest:
Can you inform me what to put into an electric sterilizer to keep
the investment from rusting?
B. F. M.
Digitized by V:iOOQIC
fTINE/y^VILDING
**Nothing but the very best of instru-
ments and materials can give your ability
the assistance it deserves." — Selected.
THE BUSINESS SIDE OF PROPHYLACTIC AND
RESTORATIVE PRACTICE*
By W. F. Spies, D.D.S., and George Wood Clapp, D.D.S., New York
SECOND PAPER
AVERAGE INCOME HOUR FEES
Analysis of reports from a considerable number of dental practices
in different parts of the United States seems to show that the following
minimum fees are necessary for each of i,ooo annual income hours to
maintain these practices in their present conditions.! These fees are
exclusive of the costs of teeth and precious metals.
$1.45
2.22
3 13
3 94
4.89
DIFFERENT FORMS OF SERVICE
The forms of dental service concerning which we are able to offer
time reports and income-hour costs for different classes of practice include
the more common forms of service comprised under the general headings
Prophylaxis and Restoration, and thus include treatment of inflammation
of the soft tissues surrounding the teeth, repair of decayed teeth and
replacement of missing teeth. No figures are offered for the operations
of orthodontia, oral surgery and full denture making.
PROPHYLACTIC PRACTICE
The word prophylaxis means ''prevention" and prophylactic ser\dce
in dentistry is devoted to preventing inflammation of the soft tissues
and decay of the teeth. Obviously the best way to prevent further
encroachment is to remove the causes of the pathological conditions.
*This article began in the January, 191 6, number.
tThese figures are taken from the forthcoming book "Profital)le Practice."
Class
I
Practices
Class
II
Practices
Class
in
Practices
Class
IV
Practices
Class
v
Practices
Digitized by
Google
PROPHYLACTIC AND RESTORATIVE PRACTICE 95
Probably the commonest and simplest manifestation of a pathological
condition of the soft tissues surrounding the teeth is first seen as a slight
reddening of the free margins of the gums. If this condition is rightly
diagnosed it usually responds readily to proper treatment. If the causes
are not removed, and proper treatment instituted, the inflammation
progresses with resulting loss of the tissues surrounding the teeth and
final loss of the teeth.
Prophylactic dental service comprises the removal of deposits upon
Fig. I. An illustration of a beginning case of Pyorrhea
the teeth, polishing the teeth, medicinal aid to the soft tissues and the
mstitution of intelligent home treatment by the patient.
SIMPLE PROPHYLACTIC CASES
Simple prophylactic cases present inflammation of the margins of
the gums due to the presence of deposits about the necks of the teeth.
They are cases which a ** cleaning '' has usually been expected to relieve.
The great trouble has generally been that the importance of the inflam-
mation has been underestimated and the '^cleaning" has been insufii-
ciently thorough.
If the standard of this form of professional service be the removal of
all irritants which caused the inflammation, and the polishing of all
surfaces of all teeth to a condition which renders them acceptable to
the soft tissues and protects them against decay of the enamel, it may
Digitized by
Google
96 THE DENTAL DIGEST
be asserted that proper prophylactic service cannot be rendered in
the short time usually devoted to a ** cleaning/'
The following reports are from the records of cases at the Pyorrhocide
Clinic. The work was performed by different operators who naturally
work at different speeds, and the averages are probably very close to the
time that would be required by a dentist of moderate speed who had
instructed himself in the proper technic. The treatment of all these
Fig. 2. An intermediate case of Pyorrhea
cases was identical. It consisted of removal of deposits by instrumenta-
tion, of polishing by means of wood points and a polishing medium, and
an average of 5 applications of Dentinol.
Thirty-one simple cases required from i to 6 hours each with a total
of 131 hours and an average of 4 hours and 20 minutes, divided into
sittings of about 30 minutes each.
The cost of these treatments involves the overhead charges, the
remuneration and the cost of materials, except precious metals.
The cost of these treatments to the dentist may be tabulated as follows:
Minimum Class I
Hourly fee $1 45
Total cost 6.30
INTERMEDIATE CASES
In intermediate cases the inflammation is more extensive than in
simple cases, there is infection and pus flow and some pocket formation,
Class II
Class III
Class IV
Class V
$2.22
S S'^S
$ 3-94
$4.89
9.60
13. 55
1705
21.20
Digitized by V:iOOQIC
PROPHYLACTIC AND RESTORATIVE PRACTICE
97
but the teeth have not been loosened beyond the power of again becoming
firm without splinting.
The treatment was identical in character with that in the simple
cases except that more time was required for each. Seventy-nine cases
required a total of 742 hours, with an average of 9 hours, 25 minutes
divided into numerous sittings.
The costs in these cases would be as follows:
Minimum Cls
Hourly fee $1
Total cost
5l
Class II Class III
Class IV
Class V
•45
$ 2.22 $ 3.13
S 3 94
$4.89
•70
^DVA
20.90 29.48
.NCED CASES
37.10
46.15
Advanced cases are marked by considerable amounts of extensive
pocket formation and pus flow, and loss of the soft and hard tissues sup-
porting the teeth, so that the teeth are often too loose to again become firm
without splinting.
Fig. 3. An advanced case of Pyorrhea
Nine advanced cases in which the teeth were not splinted were
treated in the same manner as the simple and intermediate cases, but
required a total of 189 hours, or 21 hours each. The costs of these cases
would be as follows;
Minimum
Class I
Class n
Class in
Class IV
Class V
Hourly fee . . .
. ' . $ 1.45
$ 2.22
$ 3.13
$ 3.94
$4.89
Total cost . . .
30.45
46.60
65.75
83.74
102.69
Digitized by V:iOOQIC
98 THE DENTAL DIGEST
Twenty advanced cases requiring prophylactic treatment and splints
required a total of 420 hours at the chair, an average of 21 hours; a total
of 96 hours of laboratory, an average of 4 hours 48 minutes per case; and
a total cost for precious metal and teeth of $369.25, an average cost of
$18.45 P^r case. .
In the following table, the laboratory time is estimated at the same
cost as chair time.
Minimum Class I Class II Class III Class IV Class V
Hourly fee $ i.4S $2.22 % 3-^3 $3 94 $489
Chair time 30. 45 46.60 65.
Laboratory time .... 6.95 10.65 15.
Materials 18.45 18.45 18.
Total cost 55.85 75.70 99.
To be continued.
75 83.75 102.70
00 18.90 23.45
45 18.45 18.45
20 1 21. 10 144 60
WHAT I THINK INLAYS COST
By F. D. H.. Lampasas, Texas
(Discussing the answers to, ** What will it cost you to fill this tooth.'')
In the December issue of the Digest, in answer to, ** What will it cost
you to fill this tooth," there are published nine answers, with estimated
costs running from $3.70 to $13. As each of these estimates seem to be
figured very closely, and as there is such a wide difference, it must mean
that there is a fallacy somewhere and that when it comes to actual cost
we are all up in the air, and any kind of a guess would be more accurate
than these figures. It is easy enough to tell what an operation has cost
us after it is done, but it is impossible to tell what it will cost before it is
done. Not one of these answers take into consideration the possibility of
a failure in casting or fitting, and I am sure we all have them. Quite
recently I had six large inlays of about an equal size and accessibility to
insert, five of them were put in with very little trouble, but the sixth was
cast four times before I was satisfied. Now, according to the estimates
published, I should charge several times as much for the sixth inlay as
any of the others. There are many cases where more time is consumed
in filling in a very small inlay, than one that is much larger, but the pa-
tient does not take this into consideration, and we cannot get as much for
it. The prize answer has, as an item of expense, $1,200 for dental mech-
anic; this should not properly be considered, as this department should
be self-sustaining; but if this is considered, how can we say which is pay-
ing the $3 or $5 an hour, the laboratory or the chair? It is possible that
Digitized by
Google
PROPHYLACTIC AND RESTORATIVE PRACTICE 99
the laboratory man is losing money for us, if so, our charges must be
increased in proportion. The prize answer figures fifty minutes for
investing, dehydrating and casting; all this should take only about ten
minutes of actual time consumed, as the waiting time might be profitably
used for something else. The time of a man qualified for manual labor
only, is worth something like twenty-five cents an hour; but, should he
spend several years at college, costing him, including the time spent,
$3,000, he is then in a position, by his superior knowledge, to earn, say
$3 an hour. If this $3,000 is considered in this estimate of expense, and
time still put at $3 an hour, there is a doubling up, and we are making
the patient pay for the money spent which enabled us to charge him for
such valuable time. Again, if we put $3,000 for college work, we should
also include time and money spent for preliminary education, as without
this we could not get the college work. Also ones wearing apparel is just
as necessary an item of expense as magazines. This course of logic can
be carried on indefinitely, but it seems to me, that more of these things
should be considered, save what our time is actually worth, considering
that we have, by preliminary work and expense, made it valuable.
Brother Bill or father, has already settled for these preliminary items, and
we have repaid him in love and affection and the account is closed. The
question now is: what will this filling cost us as we are now situated?
Burying the past, looking to the future, we start, with our present quali-
fications, to clear $3,000 a year. We examine the cavity, but are unable
to say what time will be required to fix it, we estimate the time from
previous records, and place it at ninety minutes of actual work, upon the
basis of one thousand producing hours a year. To earn the three thous-
and dollars, each hour must bring us in $3. But from an actual record
of oflSce expenses, let us place the figure at $1,000; (It does not cost me
nearly so much and I have a larger than a $3,000 practice). Upon this
basis we should get $4 an hour for our work, or $6 for completing the in-
lay; in my opinion, about the amount an average person will stand for
such work without kicking.
Facilities in Removing Teeth from a Rubber Plate. — Put the
plate in boiling water, keep it there for five minutes while boiling. You
will then find the rubber soft and easy to remove the teeth with any
pointed tool. While secured from cracking, they are removed thor-
oughly clean from rubber.
Brooklyn Dental Laboratory.
Digitized by
Google
100 TH£ DENTAL DIGEST
DENTISTRY FROM A HNANCIAL ASPECT*
By Percy A. Ash, D.D.S.
EdUor ^* Commonwealth Denial Review,'* Lecturer and Examiner University of Sydney, Etc.
When your Hon. Secretary conveyed to me your very kind invitation
to read a paper before this Society, he suggested the subjects of finance
and dental jurisprudence, from which I gathered that you, like the great
majority of dental practitioners, are pleased to hear something occasion-
ally a little off the beaten track of technical and scientific dentistry. I
regard it as a great compliment that you think me capable of writing an
interesting article upon such subjects, but, as the time at my disposal
must of necessity be limited, I shall leave the question of dental juris-
prudence quite out of consideration, and deal with financial affairs. Per-
haps, in order to justify myself, I should repeat that, before taking up the
study of dentistry, I spent six years in banking and commercial pursuits,
and subsequently went through four years in law as a duly articled clerk
to a solicitor, during which time I had opportunity of becoming well ac-
quainted with both the practical and theoretical aspects of money matters
as well as with the legal position in relation thereto.
In trying to decide what line of argument would prove most attractive
to you, I have been greatly help)ed by some letters I received from dentists
after the publication of my series of articles on ** Financial investments."
Among the many requests which came to hand, four appealed to me more
than others, and I thought I could not do better than confine my remarks
to them this evening. They are: —
1. Can you tell me how to succeed in practice?
2. If you write again on matters of finance, will you set out the
advantages of keeping a bank account, and also let us have some definite
information as to why cheques are "crossed," the word "bearer" struck
out, etc.
3. Explain to us, if you can, how some men who have money to lend
receive high rates of interest on good securities.
4. Will you give us a method of book-keeping whereby we can as-
certain at any time just how we stand financially?
Any one of these requests involves a subject large enough to occupy
an evening, but as they are all very important, I shall endeavor to say a
little upon each. The most difficult one to answer is No. I.
* (Read before the Odontological Society of Victoria, Sydney, Australia.)
Digitized by
Google
DENTISTRY FROM A FINANCIAL ASPECT 101
HOW TO SUCCEED IN PRACTICE
We may safely assume that the person who asked this question had in
his mind the monetary asj)ect of dentistry. We are forced to admit that,
in the commercial age in which we live, a man^s success in life is deter-
mined largely by the amount of money he makes. Though it is fre-
quently very difficult to accomplish much without money, still the acqui-
sition of it must not be looked upon as the main aspiration of human
existence. What man of any genuiiie spirit want;? to befcome rich through
the beneficence of other people? What tind'of ^^ mind is it which is al-
ways craving for a* substantial legacy- under ^scme wealthy pcrson^s will,
or for a windfall frbrh-somewhei'e/v/hidh' will- enaiile him ttt live in 'ease,
without the expenditure ofd Fca^onatile ^.nfount o! {ihtsical* and mental
energy? No man with arr^bition Of th5 right -sort hofi^es for finahcidl gain
on such terms; he desires to work for what he gets, to make his money
off his own bat, so to sj)eak, and to honestly accumulate enough during
his years of health and strength to see him through. Within the limits of
our own profession, some of us may be high-minded enough to regard as
successful anyone who has made a valuable contribution to the sum total
of scientific knowledge, or who has reached the position of a prominent
teacher in a reputable university or college, but, so far as the average man
on the street is concerned, success in a professional or business calling is
measured in money. Taking that, then, as the correct interpretation
of my correspondent's enquiry, I shall set out on the rather thankless task
of instructing others how to conduct their own business, and in the effort,
it will be necessary to mention many commonplace details, which, though
apparently insignificant, have to be reckoned with in the practice of den-
tistry where the personal equation is so much in evidence.
When you are asked to advise another how to succeed, the greatest
difficulty you encounted is an insufficient knowledge of the qualities of the
person seeking your help. If you have been successful yourself (presum-
ing, of course, that you have always been honest), you naturally dilate
on the many elements which have contributed to that end; but, more
than likely, as you proceed, you will discover that your enquirer lacks
most of the qualifications which you have found indispensable. It may
be that some practitioner, whose career you have watched for years, will
ask your advice; you know from experience why he has failed, but yet you
hesitate to say so. For instance, it requires much courage to tell him that
he lacks refinement, but yet you feel that there- in chiefly lies the reason
of his failure. There is no occupation that I know of -not excluding
medicine — where a good manner counts for so much as in dentistry, and
by this I mean a manner that is inborn and not assumed, for the real
is very readily distinguishable from the imitation, by people of gentle
Digitized by
Google
102 THE DENTAL DIGEST
birth. The fact is that very many of us in life are misfits; some in the
profession should be at something which calls for more muscle and less
brains; some who are in commercial enterprises lack the necessary quali-
fications to stand up against the keen competition in that class of business;
some are born to follow and not to lead, and hence should be in positions
where there is always a head to refer to.
H. Y. Braddon, in his book on "Business Principles and Practice/'
touching on thia feafiir^ of^J^ujuan activity, says: — "In point of fact, in
the large concerrff the j^tOrlajax^r; banks, companies or other, there is al-
'. wajiS;rc)Qii^at.tbe top.. .JQne of the depre^sipg features of business is the
V'^elatc^d^OacrgHniviilJef.tff felfiricd torlers.who ^X UJ>^Jt$jd by temperament
or lack;Qf.jTi«i:ital iiccoutremenj:, X^ g^l YP/y. ff^r. Then, too, there are
those. (iWsV.h^TOily •'fewer, rwio stei>puuof ihe ranks as the result of
intemperance or dishonesty. A really sound, well-trained business man
need never wait long for a fairly good appointment. There is always
room for him somewhere. The severe competition for places is amongst
the mediocrities. From the employers' side it is always worth while to
pay a good man well. Cheap men are rarely worth the outlay, especially
if they are working discontentedly.''
Men may have brilliant careers at universities; they may be what
is generally known as "well-read men," and be the possessors of dis-
tinguished degrees, and yet be unable to make any headway in the cold,
hard struggle for existence; that is to say, they have extraordinary capa-
city for absorbing the writings of others, but have no originality. While
in all the professions to-day the possession of a degree from a University
of repute is very properly accepted as e\adence of proficiency, still it does
not always carry the special qualifications necessary to success. Above
all things, a man must have some natural ability. In no profession, prob-
ably, is this more noticeable than in law. As we look around us we see
some barristers who have successfully passed examinations but are not
blessed with that intuitive ability which counts for so much; others are
able to add to their legal knowledge, keen powers of perception, ready
wit, the natural facility to grasp an opportunity the moment it arises,
and many other attributes which contribute to success. The one bar-
rister conducts his case, relying almost entirely on his knowledge of law,
which he gained from books and Acts of Parliament; the other, in addi-
tion to those qualifications, brings his personal resourcefulness to bear,
observes the slightest discrepancy which arises during the progress of the
case, snaps it up and makes capital out of it. The same conditions hold
good very largely in our own profession.
The Australian Journal of Dentistry.
{To be continued)
Digitized by
Google
/
\
A SYSTEM OF DENTAL BOOK-KEEPING 103
A SYSTEM OF DENTAL BOOK-KEEPING
By F. a. Ross, D.D.S., Gilroy, Cal.
My object in this article will be to outline a system of dental book-
^ping which six years' use in practice has demonstrated to be simple,
^ ^^omical, complete in all essentials, and to require a minimum of time
^,. ^ effort on the part of the dentist. The system is not wholly original
lu ^ rne, being rather an amplification of a stock system on the market in
^t^. ^^-leaf ledger form, from which I have evolved the other details as I
K ^^1 a requirement for them in my practice.
V/^^CJ^mong the advantages of this system are the following: it leaves
H^^ing to the memory, even for an hour; it enables one to strike a
^\lce or check up his volume of business for any period of time, a
T^t^t, month or year, in a few minutes' time; it requires only a few
minutes' time daily, and an occasional couple of hours, say once a month,
to index and transfer accounts and enter new leaves.
The first item in the system consists of a 4 x 6 in. sheet of paper,
ruled as in Fig. i, and which I call the day tag. On assuming business
for the day I slip one of these sheets into the type-writer, noting the
date in the space above the horizontal lines. Thereafter, during the day,
upon dismissing a patient, and before beginning the next operation^ I jot
down in the lower space the name of the patient just dismissed, with a
note, in detail, of the operation performed, together with the charge
therefore, and credit any amount paid, in the spaces provided by the
ruling at the right hand side of the sheet. This I do with each suc-
ceeding case throughout the day, and by using abbreviations in noting
down the operations I find that one line is usually all that is required per
patient, so that a sheet is usually sufficient to record all operations for
one day. The use of the typewriter of course makes for economy of
space. While its use is a refinement, and makes for neatness, order, and
legibility, it is not essential. The notations can be made in pencil, and
the sheet kept on the cabinet beside the chair if preferred. I did it that
way for three or four years before I had a typewriter.
Now let us take a sample day's run in the oflSce, and see how it works.
Our first appointment in the morning is with Mr. Jones, for whom we
devitalize the right upper first molar, and put in an amalgam filling in the
left upper second bicuspid. We record it thus: F. Jones, T. 3, N. O. A.
13- T. stands for treatment; N. for novocain (denoting that I used
peridental anaesthesia for pulp removal) ; 3 denotes the number of the
tooth operated upon, as found on the i)age in the ledger devoted to Mr.
Jones's case. Similarly, A. means amalgam, and the number denotes the
tooth. He also paid a deposit.
Digitized by
Google
104 THE DENTAL DIGEST
JANUARY I, I916
F. Jones, T. N. 3; A. 13
H. Johnson
Willie Hooper, sed. Ir. 19 ...
Mrs. J. Smith, G. 9, analg. .
Mr. Willson, scaling, emet. Alcresta
Miss Allen, r. c. f. cr. pr. 5
Mr. White, ext. 2-3, N20 ...
Rent, $30
Fig. I. The Day Tag
4.50
2S.CX>
13.50
■50
9.00
5 00
5.00
3 00
3 50
3SO
$25.50
$47.00
Our next appointment is with Mrs. Smith, for whom we insert a gold
filling in the left superior central. We also used analgesia in the
preparation of this cavity. Hence, ''Mrs. Smith, G. 9, analg." But
during the time Mrs. Smith was in the chair Mr. Johnson called and paid
his account of $13.50. We put that on the tag then and there. We are
pretty busy with that gold filling in Mrs. Smith's mouth, but that is all
the more reason why we stop and jot it down. If we wait till after 5
P.M. it may slip our mind, and so lay grounds for future trouble when we
send Johnson another statement and he comes in and declares he paid us,
and we don't remember it nor have any record of it. Also little Willie
Hooper came in with a toothache during the time we were busy with Mrs.
Smith's case, and we sealed in a sedative treatment to keep him com-
fortable until another day when we could give him more attention. So
we slip in a memorandum on our day tag, and thus perhaps save our-
selves 50c. which we possibly would have forgotten to charge up to the
account if we had waited until after our day's work was done before
making up our record of the day's transactions, from memory.
Our next patient is Mr. Willson, a pyorrhea case. We scale some of
his teeth, apply emetine solution, and prescribe a course of Alcresta
tablets. He paid $5 on account.
I wish to interpolate here that I find a second operating chair a great
help in handling such cases as Willie's, which come in during the progress
of a long operation. It minimizes the time lost by the interruption.
Also, I wish to mention another thing which saves a great deal of time
and lost motion. That is the use of an examination record. I use the
Allen examination book, making a thorough examination of the teeth at
the first sitting, outlining on the cut of the teeth given on each page the
cavities found, treatments necessary, etc., also noting down any estimate
made, agreements about payment of account, etc. Then at all subse-
quent sittings I work from this chart, checking off each piece of work as
it is completed and noting any changes made from the original plan of the
work. This saves time hunting around the mouth to see what to do next,
avoids overlooking concealed cavities which were found in the first
Digitized by
Google
SYSTEM OF DENTAL BOOK-KEEPING
105
diligent examination, and is a first hand memory tickler regarding the
details of the case that one would not purposely overlook, but which are
soon and easily forgotten. Estimates and agreements are later trans-
ferred to the permanent case record in the ledger.
JANUARY
1916
January 1
2
3
4
5
6
8
9
10
II
12
13
15
16
17
18
19
20
22
23
24
25
26
27
29
30
31
Rec'd
Booked
$37 50
$30.00
500
23.00
550
22.00
13 50
19 50
26.00
20.00
18.00
11.00
7.00
24.00
300
14-50
28.50
20.50
6.50
29.50
5.00
1. 00
21.50
19 50
43 00
6.00
22.00
107.00
43.00
1500
32.00
14-50
S-oo
29.00
129.00
30.50
8.50
29.00
20.50
14 50
5.00
19 50
26.00
30.00
67.50
51.00
6.50
16.00
14.00
22.00
$552.50! $671.50
Fig. No. 2. Bkiifiister cash and bill card (pink) for adding up totals
The other items on our day tag show that we filled the root canals
in the right upper first bicuspid, for Miss Allen, and prepared the tooth
to receive a crown; also extracted the right upper first and second molars
for Mr. White, using nitrous oxid oxygen anesthesia for the operation.
He paid in full.
Thus we note down on our day tag all the transactions of the day
each in turn and at the moment, and at the close of the day's work add up
the totals in the charge and credit columns. After transferring the
items on the day tag to the individual records in the ledger, the day tags
are filed in a drawer in the desk until the end of the month. Then I use
a Bannister cash and bill card (pink) on which to add up the totals of all
the day tags of the month, thus securing totals showing all charges and
receipts for the month (Fig. 2). The day tags and the pink card, I then
place in another drawer along with tags and cards of previous months.
At the end of the year, by simply adding up the twelve totals shown on
the pink cards I have a summary of receipts and charges for the year.
Digitized by
Google
106
THB DENTAL DIGEST
We now come to the case records. For this purpose I use a modifica-
tion of the loose leaf ledger made by the Workman Manufacturing Com-
pany, 1 200 W. Monroe St., Chicago. They call it their No. O special.
My objections to their original stock record sheets are that there is some
needless repetition in the headings; there are some headings I do not
need, and some not given that I do need; I prefer a different arrangement
of the headings; the original is provided with case record ruling on one
side only. Therefore I had them print leaves to order (Fig. 3) which
meet my requirements very much better, and by having both sides alike
provides double the record space in a given bulk of sheets. I had these
0
=0
IBS
III lllilVIV^'l'.') ■- V ^TTil
ffl^AS^M "^ Jf9-^'d^^.
^H'»'fJH»
II IIP IN -
bM
UsiLi- a
f'k' 4f a .
tttfi
*
--
Fig. No. 3. Loose leaf ledger
printed before I took up the use of nitrous oxid. My next order will
provide headings to include analgesia and anesthesia. I now make a
note of its use in the ** Remarks" column.
The manner of making up the case record is obvious from illustration
No. 3, We have the patient's name and address, together with a memo-
randum of the amount of his contract and terms of payment. There is
a space to note by whom he was referred to us. We have entered the
first item o£ Mr. Jones's account, as taken from our sample day tag.
Succeeding operations will be entered from other day tags as the case
progresses.
The accounts in this loose leaf ledger are self indexed by means of
yellow sheets having the letters of the alphabet arranged on projecting
celluloid tabs, and the account leaves under each index sheet are arranged
with projecting tabs on which the name of the patient is written so that
it is instantly found upon opening the ledger at the proper index sheet.
Digitized by
Google
A SYSTEM OF DENTAL BOOK-KEEPING 107
Thus, to find the account of our first patient, Mr. Jones, we open our
ledger at the celluloid tab "J." Without turning a single leaf, we see
the name we are looking for on the projecting tab.
Also, all the other current accounts of patients whose names begin
with J. are before us at a glance.
Accounts are kept in the original binder as long as active, or until
paid. About once a month, or whenever convenient, paid accounts are
removed and placed in another binder, called the transfer binder. Be-
fore inserting into the second binder the projecting tabs are cut off. A
photographer's print trimmer facilitates this operation, and gives a
true edge to the leaves. The transferred leaves are paged numerically,
and for this purpose I use a Bates numbering machine for the sake of
neatness and legibility, though it can be done \/ith pen and ink if one
does not wish to invest in a numbering machine.
The name on each account that is thus transferred is entered on the
yellow indexing sheet in the original ledger, together with its page num-
ber, under vowel headings which make it possible to find a name in a
minimum amount of time. Thus an account, whether active or closed,
can be found in the one ledger, and located in a few seconds' time.
By thus transferring closed accounts, the original binder is reserved
for active accounts, and when sending out statements at the end of the
month it is not necessary to search through a large volume of accounts
and weed out the active from the closed. In fact, I usually run through
the ledger in a few minutes and type down on a plain sheet of paper, in
alphabetical order, all the accounts requiring statements, and then
make out statements from this list. By preserving this list, and at the
next statement period adding the new accounts that have accumulated
during the month, I reduce the task of statement rendering to a minimum.
Of course, in this system, one could, if preferred, substitute the card
system for the loose leaf ledger. The principal advantage of the ledger
is the reduction of bulk. One transfer binder will hold a thousand or
fifteen hundred sheets. The binder posts are added to in sections as the
binder fills up, and it is optional how many leaves are put into one volimoie.
The difference in volume between 1,500 sheets and a similar number of
cards, with indexes, is considerable.
The only other item in the system is an ordinary double ruled cash
book in which are entered the receipts shown on the day tags, together
with expense items as they occur. On adding up at the end of the month,
the total in the cash book should tally with that on the pink card in the
"Received" column. If it fails to do so, the month's Receipts can be
checked up on the day tags and the error found.
By having pink tags ruled to order, another column could be added to
Digitized by V:iOOQIC
108 THE DENTAL DIGEST
include the expense account. At present I keep this only in the cash
book.
At first, upon reading this over, it may seem as though there is con-
siderable labor involved in this method. I have gone more or less into
detail, and it may sound complicated in the telling, but in actual use the
amount of time it requires is negligible. A few seconds after each opera-
tion, with five or ten minutes at the end of the day, and a couple of hours
every month or so is all the time required, and it is time well spent I be-
lieve, considering the results it yields.
As a matter of fact, the whole thing can be turned over to an office
girl, with the exception of the notations on the day tags. A thoroughly
trained girl might even be entrusted with that too, but as office girls go I
would prefer to attend to that myself. With all items correctly entered
on the day tag, the girl's errors in entry can always be traced and cor-
rected. Personally I prefer to attend to my own bookkeeping, limiting
the girl's share in that to bill sending and looking up the accounts of
people who call to settle while I am busy at the chair.
I have been prompted to present this article by the fact that several
of my dentist friends, happening to see my system, have asked me to
explain it to them, and upon my doing so have given it their thorough
endorsement, and have adopted it in their own practice. Since it
appealed so strongly to those who have seen it, it occurred to me that
perhaps there might be others who would be glad to learn of it.
Should any of my fellow Digest readers find any helpful suggestions
in this article, I shall be well repaid for the effort spent in its preparation.
First National Bank Bldg.
TWO GOOD PRACTICAL HINTS
Waxed Silk : — Purcjiase yourself a ball of silk twist or silkateen
from your dry goods store; place same in cup with sufficient beeswax
to cover when melted, boil thread in wax for one minute, remove
your thread and let cool. Then you have a fine ball of waxed thread
through and through, always ready for your use.
Good Probe: — Remove wood from common lead pencil, take a
stiff piece of wire, bend one end so as to make a handle; on the other
end use small binding wire; fasten the graphite removed from pencil;
sharpen graphite. Then you have a probe with which you can push
your melted gold around without it adhering to probe.
C. I. Faison, D.D.S., Dallas, Tex.
Digitized by
Google
ESTABLISHED METHOD OF TREATMENT 109
ESTABLISHED METHODS OF TREATMENTS MUST
BE FOLLOWED
. {Wisconsin). — In the case of Allen v. Voje, recently tried in the
)^^sconsin supreme court, the principle was laid down that a physician or
^ ^^tist in treating a patient must follow the established methods of
<i>^ .^^tment. A departure from approved methods in general use, if it
^^^ ^^^s the patient, will render him liable, however good his intention
"^^^-^O^ have been. It is however, not necessary that a physician or
\\ ^5t adhere to ancient methods of treatment. He must keep abreast
^\ie times. Some standard by which to determine the propriety of
Xx^utment must be adopted; otherwise experiments will take the place
of skill, and the reckless experimentalist the place of the educated,
experienced practitioner. When the case is one as to which a system
^{ treatment has been followed for a long time, there should be no de-
parture from it, unless the surgeon who does it is prepared to take the
^sk of establishing by his success the propriety and safety of his experi-
ment. The rule protects the community against reckless experiments
while it admits the adoption of new remedies and modes of treatment
only vrhen their benefits have been demonstrated, or when, from the
^ecessity of the case, the surgeon or physician must be left to the exer-
^^•se of his own skill and experience. The skilfulness of a physician in
^^^Tiosis and treatment should be tested by the rule of his own school.
-ft seems to be a sound and reasonable rule and well established by the
^-O-o Titles that the treatment of a physician or dentist of one particular
^^^-^J is to be tested by the general principles and practices of his school
• , ^^ not by those of other schools, and that a physician, surgeon or dentist
^^Vand to exercise such reasonable care and skill as is possessed and
Qf ^^ised by physicians, surgeons and dentists generally in good standing
^j^^ ^^« same system or school of practice, or treatment in the locality
q{ ^^ommunity of his practice, having due regard to the advanced state
^r» *Ve school or science of treatment at the time of such treatment.
xq ^^^ a patient selects one of the many schools of treatment and healing
^^^^^^rve him, he thereby accepts and adopts the kind of treatment
^^^ he is treated, when questioned in a court of justice, should be
^d by the evidence of those who are trained or skilled in that school
v^^ ^ ^Tion to that school or class, and the care, skill, and diligence with
^lass. (Allen v. Voje, 114 Wis., i).
PROFESSIONAL CONDUCT
{Kentucky). — Kentucky Statutes, providing that the board of health
^^y suspend or revoke a physician's or dentist's license, (i) for the pres-
Digitizedby V:iOOQIC ^-^
110 THE DENTAL DIGEST
entation to the board of any license which was illegally or fraudulently
obtained, or the practice of fraud in passing an examination; (2) for the
commission of a criminal abortion, or conviction of a felony involving
moral turpitude; (3) for chronic or persistent inebriety, or addiction to a
drug habit to an extent which disqualifies him to practice with safety to
the people; (4) or for other grossly unprofessional or dishonorable conduct
of a character likely to deceive or defraud the public is construed to create
a definite standard by which professional conduct may be measured, and
is a valid exercise of the police power.
And although a physician or dentist may violate the professional
code by advertising, his act will not constitute a ground for revoking his
license, unless his conduct is dishonorable, fraudulent, and involves moral
turpitude within the contemplation of the above statute. (Forman v.
State Board of Health, 162 S. W., 796.)
PAYMENT OF PROFESSIONAL SERVICES
(Mimtesola). — Where defendant requested plaintiff, a dentist, to
render defendant's niece professional services, who was a member of his
household, her parents having been divorced and did not inform plaintiff
that the patient was not his daughter or that he did not expect to pay for
the services, he is chargeable for the value of the services rendered under
an implied promise. (Bigelow v. Hall, 152 N. W., 763.)
CURATIVE PROPERTIES OF MEDICINE
(Federal). — One may not be convicted under the Food and Drug Act,
merely because he advocates a theory of medicine which at the time has
not received the sanction of the profession ; but one guilty of fraud may not
escape conviction merely because some one may honestly believe in the
theory which he fraudulently set forth. In United States v. American
Laboratories defendant was prosecuted on the ground of having fraudu-
lently advertised the curative properties of certain patent medicines.
The defense was that the medicines contained curative properties as ad-
vertised.
A jury in the United States District Court found the defendant
guilty of fraud in advertising its medicines to contain properties which
as a matter of fact was mere belief and speculation. The court held it
unlawful to advertise any medicine as a cure unless known to be positive
(U. S. V. American Laboratories, 222 Fed., 105.)
COUNTY NOT LIABLE FOR SERVICES
(Georgia). — Where a dentist, at the instance and upon the request of
the sheriff, performs a dental operation upon one who is a prisoner in the
Digitized by
Google
A REQUEST FOR ADVICE 111
custody of such sherifT, an action cannot be maintained by the dentist
against the county to recover the value of such services. (C. T. Nolan
V. Cobb County, 8i S. E., 124.)
A REQUEST FOR ADVICE
Editor Dental Digest:
I have been for some time very much interested in your articles on
the business side of dentistry, and am sending a more or less disconnected
request for advice.
I have many hours that should be filled, that are riot, and want my
practice to come from the good I may render my patients by rendering
to them such services as I would want rendered to me or my mother or
my wife.
For such honest services I want an honest fee.
You probably know as well as I that many men with large practices
render services, to the patients who trust them, that would not be passed
in the school in which I received my dental education, Harvard.
By such work, to my mind, the patient is not getting the services to
which he is entitled or a square deal.
The public is ignorant as to the proper care of the teeth, and the
results following the neglect of such care.
If I use printer's ink in educating them along those lines, and to such
as come under my care, as a result of such use of said ink. render the best
services I am capable of, in an honest effort to help them by putting their
teeth in good condition, am I not as ethical in a broad sense, as the society
man who puts into their mouths such work as we all see, and takes good
money for it?
I feel that fees are much too low for real honest work and that may
be the reason why we see so much work that is not what it should be and
is a disgrace to the profession.
How can a man properly cleanse the teeth for $1?
How can he treat and fill, properly, a molar for $3?
How can he use a high grade alloy like Twentieth Century, carve,
contour, line with cement and polish for $1 or $1.50?
How many of them let the girl at the tooth counter pick out the teeth
and the dental laboratory make the denture?
How many of them try to tell the patient that the alloy filling is a
means of restoring the teeth to comfort and usefulness and that it mav be
Digitized by
Google
112 THE DENTAL DIGEST
much better for them than a gold crown, and many times takes as much
time and skill, and is worth money to them, the patient?
How many of them are telling the patient that they are selling services
and not fillings, and will charge as much or more for a so-called silver
filling, if it takes time, than for a small gold one?
How many of them are trying to get an)^ more for their services than
they did lo or more years ago? Shouldn't they?
What is the difference between a so-called honest ethical dentist and
an honest unethical one. I mean honest with himself and his patient?
Do you not think a man who uses printer's ink can be as honest with
his patients as one who does not?
We must live and if it is an honest living what's the difference?
If you were in practice and it was necessary' to increase your produc-
ing time, what would you do.
Very truly yours,
Massachusetts.
Rditor Dental Digest*:
Having read the Digest for several years, it has occurred to me that
you might know some dentist in or about Boston who has put into prac-
tice the ideas expressed in the Digest in regard to fees. About a dozen
of the dentists in this county have formed a society, and we have been
looking around for someone who would be willing to give us a talk on
those lines. If you could suggest anyone whom we might get in touch
with, it will be much appreciated. I wish to congratulate you on the
work the Digest is doing in this direction. I believe it has done more
for the advancement of dentistry than all the other journals combined.
Sincerely yours,
Boston.
CAN ANYONE GIVE INFORMATION?
Editor Dental Digest:
I am one of the satisfied Digest family.
I wish you to let us have some information on how to choose a dental
location. You have told us how to increase fees and save time, but in
looking for a location, I want to know just how to go at it. Points to
take into consideration, etc.
Yours very truly,
Washington.
* If our readers know of anyone who has put into effect the business building suggestions
of The Dental Digest the editor will be glad to have him address " Boston," care of The Dental
Digest, 220 W. 4 2d St., New York.
Digitized by
Google
fkmoL Hints
[This department is in charge of Dr.
V. C. Smedley, 604 California Bldg.,
Denver, Colo. To avoid unnecessary de-
lay, Hints, Questions, and Answers should
be sent direct to him,]*
A Painless Way to Open a Sore Tooth. — In opening up a very sore
tooth when the patient cannot stand the pressure of the bur, I find the
following method very good. Take your dentimeter and make a wire
loop as if taking a measurement for a crown. Then let your assistant
pull on the dentimeter while you open up the tooth. Or better yet, let
the patient help you by holding dentimeter, then if it hurts they will
equalize the pressure by pulling a little harder. — James J. Jones, D.D.S.,
Scottsbluff, Nebr.
To Repair a Hole in a Bicuspid or Molar Crown. — Take a clean
piece of asbestos paper and cut out a disc that will fit inside the band.
Place occlusal surface on something flat and press the disc down firmly
and evenly. Moisten several pieces of asbestos and fill up the crown.
Place on a charcoal block and turn on the flame of the blowpipe. Cut a
piece of solder large enough to cover the hole and place it in position. Flux
well and turn on the heat. When the solder starts to curl on the edge,
turn it down with a pointed slate pencil, and keep applying the heat until
the solder is caught all around. With a little practice, you can drag
solder around almost any place with an ordinary slate pencil. If the
crown is on a bridge, wrap the bridge with asbestos paper, wiring it on,
and proceed as above.
An Ordinary Hail Screen. — If you are afraid that your investment
will crack and pull away when soldering a big bridge, invest the bridge
on a piece of hail screen cut to suit the case. A piece of hail screen also
makes a very handy thing to place over the spider of your gas or gasolene
stove on which to place an investment of any kind. — Harry M. Tweedy,
D.D.S., Smith Centre, Kansas.
To Tighten Old Plates. — If you want to delight the next patient
for whom you repair an upper plate, just previous to investing, flow a
rounded **bead" or ridge of wax just inside the border clear around the
periphery of the plate.
*ln order to make this department as live, entertaining and helpful as possible, question?
and answers, as well as hints of a practical nature, are solicited.
Digitized by
Google
114 THE DENTAL DIGEST
Did you ever notice blisters on the plate where a bubble was, in repair
jobs? Well, that is what happens in this case. The wax bums out and
the rubber expands there. — ^J. F. Adams, D.D.S., Clinton, Ind.
To Remove an Inlay Model from a Difficult Cavity. — ^Hold the
end of a piece of number 40 copper wire in the flame of an alcohol lamp
until a globule of metal is melted on it. Seize the wire about a sixteenth of
an inch from the end with a pair of dressing pliers. Heat the pliers until
the globule is hot, place it against the wax model permitting the metal to
melt into the wax, and cool it. Force applied to the wire now will cause
the wax model to leave the cavity along the lines of least resistance. The
wire may now be cut close to the wax and the sprue attached. — F. H.
Miller, D.D.S., Aylmer, Ont.
[I would suggest the substitution of gold for the copper wire here, as
the globule of copper would mar your finished inlay, if it happened to be
cast into an exposed portion of same. — V. C. S.]
When Glower Burns out in the Dentiscope Lamp. — ^To avoid
delay and inconvenience while waiting for a new burner from supply
house, remove lighting device from the ground glass shade and turn on the
current; when the heater is at the maximum temperature touch the
broken glower together and it will fuse at the break; have used one glower
over a year that has broken several times. — George E. Cox, D.D.S.,
Wilmington, Delaware.
A Method for the Correct Application of Davis Crowns to
Roots. — To prevent failures due to displacement of crown and weakening
of cement during process of cementation, caused by movement when
holding crown with fingers. After the root is treated and filled, grind
root as usual, apply post to root, having collar on post flush with surface
of root, apply crown and grind wh«re necessary, and after obtaining the
conditions necessary for an ideal substitute of the missing tooth, cement
the post in the root. Then attach the crown to post and root with gutta-
percha, obtaining correct alignment of crown before hardening of gutta-
percha. If opposing tooth strikes the crown, grind at this point. (If
crown becomes loosened during grinding re-attach with gutta-percha.)
After hardening of gutta-percha and conditions are ideal, take impression
(not bite) of crown and adjacent teeth with modelling compound, chill
and remove. Remove crown and all gutta-percha, dry with chloroform
and hot air. Apply crown to root with cement, place impression over
crown and apply steady pressure, until cement has hardened. Remove
impression and trim away aft excess of cemeftit. If the technic is still
fully performed and all moisture excluded you will get results impossible
with the old method of holding with the fingers. This method consumes
Digitized by
Google
QUESTIONS AND ANSWERS 115
more time but it pays in the end. — Monreith Hollway, D.D.S., Buffalo,
N.Y.
Extracting a Post from a Frail Root. — In extracting a post
from a frail root with a post puller there is always danger of splitting
the root. The likelihood of this happening may be reduced to the
minimimi by taking a piece of twenty-eight gauge German silver plate,
cut a hole through it large enough to pass over the post and trim into
a disk about the size of the root face. This disk may then be placed
on the root with post projecting through its center. The post puller
may then be placed in position and as it is tightened the part of the
instrument which is intended to bear on the root rests against the metal
disk and does not slip or spread and the post may be drawn with safety.
If the face of the root is uneven from decay, a bit of base-plate gutta
percha may be molded into the cavity, the disk pressed into place and
chilled with cold water, giving an even base for the instrument to press
against. — ^J. A. Bullard, D.D.S., Chicago, 111. —The Denial Review,
QUESTIONS AND ANSWERS
Question No. i. — ^What metal is best for castings, to be used under
gold crowns, for the purpose of building up badly decayed roots to support
crowns? Would there be danger in using coin silver, containing ten per
cent, copper, in case the crown failed and exposed the coin silver to the
secretions of the mouth?
Question No. 2. — Would like the name and address of an insurance
company, that insures dentists against malpractice suits. I believe every
dentist should carry such insurance, when our doctors are blaming crowns,
and bridges, whether they are sanitary or not, for case after case of sys-
temic disease. — G. W.
Answer No. i. — I see no serious objection to the use of coin silver for
the purp)ose you suggest, though I cannot speak from experience with it.
I do, however, use pure silver for this purpose and find it entirely satis-
factory.
Answer No. 2. — I am told by an insurance man here that any of the
companies carrying protective policies for physicians and surgeons insure
dentists on the same basis. There are probably other companies doing
the same thing, but he gives me the names of these: Fidelity & Casualty
Co., and Maryland Casualty Co. Rate $15 per thousand. Limit
$5,000 for one suit and limit $15,000 for one year, — V. C. S.
Question. — Will you please give me a simple method of employing the
aqua regia-ferric process of separating gold or gold alloy from platinum.-—
C. B. K.
Digitized by
Google
116 THE DENTAL DIGEST
Answer. — ^Answering your question on how to separate platinum
from gold alloy. First add silver to reduce alloy to 6k. Dissolve silver
and copper with nitric acid and wash residue thoroughly in water. Dis-
solve residue, which should now be pure gold and platinum, in aqua regia
(one part hydrochloric and two parts nitric acid). Precipitate gold with
sulphate of iron. Filter and wash. Precipitate platinum with solution
of ammoniae. Filter and heat in crucible to white heat, just burning
filter paper out. This when cool gives you sponge platinum which had
best be sent to a platinum refiner to melt and roll. — V. C. S.
Answer. — In Practical Hints, November issue of the Dental Di-
gest, Dr. M. M. Brown, of Macon, Miss., under hint number three,
refers to the use of a sheet of bibulous paper for squeezing out the excess
of mercury from amalgam. A better way still is not to have any excess
mercury in the amalgam. Secure a little mortar and pestle, first pour
the desired amount of mercury in the mortar, then a little alloy, and mix
in; then continue to add alloy until all mercury is mixed in to a firm mass;
take amalgam from mortar with fingers to a piece of rubber dam, in this
rub rapidly in palm of hand in order to evenly unite all particles of alloy
and mercury. In this way you have a perfect mixture and a clean filling
material. — M. L. Brockington, Florence, So. Car.
Answer. — In the November issue of the Dental Digest I find a
recommendation of atomized alcohol for cleaning the synthetic slab and
eyeglasses. I have found another excellent use for this alcohol, namely
cleaning mouth mirrors which have become dirty in any way from use in
the mouth. While I am working for the same patient I do not claim to
sterilize my mirrors by this method. The alcohol when wiped off takes
whatever dirt there was with it, and leaves the mirror clean and clear
which is a great aid to one who works almost entirely with the mirror. —
Horatio C. Meriam, D.M.D., Salem, Mass.
Answer. — In the last issue of the Digest I read about coating strips
and discs with soap to facilitate polishing hy doing away with unneces-
sary friction and to also aid in recovering the otherwise wasted gold.
Would say that I have long been using cocoa butter for this purpose and
believe it better. It is put up in handy form and less objectionable to the
patient. Also instead of coating engine belt with beeswax and resin to
make it hold tightly, try slipping a small rubber band into the pulley
groove on both engine and handpiece. It will work. You can run the
belt more loosely thereby prolonging its life and saving wear on all bear-
ings concerned. The belt dressing previously mentioned doubtless would
dirty the belt and leave a bad streak on your white coat should the belt
chance to rub the latter as is often the case.— F. W. M.
Digitized by
Google
AN EPITOME OP CURRENT DENTAL AND MEDICAL LITERATURE 117
AN EPITOME OF CURRENT DENTAL AND MEDICAL
LITERATURE
[The Dental Review^ January, 1916]
Contents
Original Communications
*The Dental Pulp and Periapical Tissue: Diagnosb and Prognosis of Their More Common
Pathologic Conditions. By William H. G. Logan.
The Business Side of Dentistry. By Guy F. Corley.
Root Canal Preparation. By J. R. Callahan.
Why Some Fillings Fail. By R. Rodgers.
•Extraction of Teeth as a Surgical Operation. By E. L. Teskey.
Proceedings of Societies
Illinois State Dental Society, Fifty-first Annual Meeting Held at Peoria, May 11-14, 191 5.
Wisconsin State Dental Society, Forty-fifth Annual Meeting Held at Oconomowoc, July
Chicago Dental Society.
Editorial
The Best Year Yet.
Practical Hints Memoranda.
THE DENTAL PULP AND PERIAPICAL TISSUES: DIAGNOSIS AND PROGNOSIS
OF THEIR MORE COMMON PATHOLOGIC CONDITIONS
By William H. G. Logan, M.D., D.D.S., Chicago, III.
Cardinal symptoms and findings accompanying that contraindicate
the efort to save the pulp's vitality when the root ends are fully formed,
A. — ^All pulps exposed by dental caries should be considered infected,
therefore removal in every instance is indicated. B. — When a pulp has
been exposed by accident and the tissue injured, for example, by exca-
vator or bur, the vitality of the pulp cannot be permanently maintained.
C. — Remove the dental pulp in those cases where carious dentin is found
lying in contact with it. D. — When the paroxysms of pain have been of
one or two hours' duration or have become constant and occur with or
without the application of a known irritant and are most pronounced at
night, the prognosis of this pulp's vitality is hopeless. E. — When a tooth
becomes sore under pressure as result of a periapical inflammation caused
by the pulp disease spreading by continuity to the tissues beyond the root
end, begin treatment that is to terminate in the filling of the root canal.
F. — Every pulp should be removed when the pain is momentarily re-
lieved by the application of cold water.
In the application of the above statement, let it be remembered they
Digitized by
Google
118 THB DENTAL DIGEST
only have reference to pulp diseases in teeth that have reached full
development.
Pulp capping with our present technic should be looked upon as a
doubtful procedure in all cases after the root end has formed. I believe
to cap a pulp that has been exposed by either dental caries or from the
removal of carious dentin that was lying in contact with the pulp is to
court positive failure. However, many careful operators have suc-
cessfully capped pulps before the root end had fully formed, that were
exposed in the process of cavity preparation by opening through a thin
layer of normal dentin. I believe there is an agreement that it is wise
in many instances to cap pulps for the purpose of maintaining the pulp's
vitality as long as possible, when we wish the benefit of the activity of
the odontoblastic cells to complete root end development.
EXTRACTIONS OF TEETH AS A SURGICAL OPERATION
By E. L. Teskey, Shabonna, III.
Impress on the patient that the extraction of a tooth is no simple
operation, that it requires skill and care and that the result may be serious
if not properly performed; then quiet the pain, put the tooth at ease,
give a cathartic and send him home until the next day. On his return
proceed to prepare the mouth by cleaning all the teeth, washing out the
nose and throat, rendering the field as aseptic as possible. That this
cannot be complete is no reason that it should not be attempted. Have
all instruments and hands sterilized as carefully as for a major operation;
now proceed as the case indicates, using a general or local anesthetic as
desired. Be sure that there will be no pain and that you will have plenty
of time to do the work thoroughly. Remove all of the tooth, using no
more force than is needed, and if it is necessary to lacerate the gum,
dissect it out of the way, so that there will be no contusion of the soft
tissue. Carefully wash out the wound with sterile water and replace the
gum tissue in normal position; dismissing the patient for the day. The
patient should be fed with soft food until the wound is healed. The
dentist should see the case every day until there is no danger of a second-
ary infection.
I know you will say that the patient will object to the trouble and be
unwilling to pay for it, but I believe that when the patient understands
the seriousness and importance of the operation these would be second-
ary considerations. In the meantime work toward this end.
Within my memory the public went to the jewelers an 1 traveling
peddlers for their glasses, but now the oculist has no trouble in getting
good fees for his services and the patient is satisfied. The first thing is
to realize the seriousness of the operation ourselves and then educate
Digitized by V:iOOQIC
AN EPITOME OF CURRENT DENTAL AND MEDICAL LITERATURE 119
the public. This is an age of education; the people are awaiting the
teachers; it is up to you.
In conclusion I can see it in no other light than that the general
surgeon is either a charlatan and working for effect, or the dentist is
careless and not giving the people the best that is in him.
[The Dental Cosmos^ January, 1916]
Original Communications
♦Mandibular Anesthesia. By Theodor Blum, D.D.S., M. D.
The Application of Local Anesthesia to Dentistry. By Leo Stern, D.D.?.
Indications for and Construction of Fixed or Removable Bridge Work. By Thomas P.
Hinman, D.D.S.
The Importance of Biology as Applied to Dentistr>'. By Dr. Ch. F. L. Nord.
The Germicidal Efficiency of Some Copper Cements Used in Dental Work. By R. F.
Bacon, Ph. D.
A Contribution to the Study of Faces. By L. G. Singleton, D.D.S.
*The Irrationality of Bacterial Vaccines in the Treatment of Pyorrhea Alveolaris. By A. H.
Merritt, D.D.S.
Practical Value of Mouth Hygiene. By H. W. Wiley, M.D.
Correspondence
A Rejoinder by Dr. Rhein.
"Square Deal" Examinations.
Proceedings of Societies
Pennsylvania State Dental Society.
Susquehanna Dental Association of Pennsylvania.
Editorial Department
Retrogressive Reform.
Legal Protection of the Examinee.
Bibliographical.
Review of Current Dental Literature.
Periscope.
Hints, Queries, and Comments.
MANDIBULAR ANESTHESIA
By Theodor Blum, D.D.S., M.D., New York
Oral Surgeon and Dental R'dnigenologist, New York Post Graduate Medical School and Hospital
writer's TECHNIC
I will now describe the technic of mandibular anesthesia which I
am accustomed to teach. It is similar to SeidePs method, modified only
by using the index finger of the left hand for palpation and the right
hand for injecting on the right side, and vice versa; the bevel of the heavy
steel needle is turned toward the nerves and away from the bone.
Digitized by
Google
120 THE DENTAL DIGEST
Let us say, for example, that we wish to give a mandibular injection
on the right side. The patient is requested to open his mouth, and with
the index finger of the left hand, the external oblique line is found. Now
the ball of the same finger is placed over the retro-molar triangle in such
a manner that the fingernail touches the internal oblique line; this
finger is moved slightly laterally to free the internal oblique line — ^iii
which position the finger remains throughout the injection — ^and the
area is painted with iodin; the syringe, is grasped with the right hand,
like a pen, and the needle is run i cm. above the occlusal plane of the
lower jaw through the soft tissues directly to the internal oblique line;
the needle is retracted somewhat, so as to release it from the periosteum,
and moved — the syringe is in nearly sagittal direction — mesiaUy until
one finds no more resistance to proceeding backward, i, e, when, after
passing the internal oblique line, one arrives at the mesial aspect of the
ascending ramus. About five drops (0.3 cc.) of the solution are injected,
to anesthetize the lingual nerve. The point of the needle is placed in
contact with the mesial aspect of the ascending ramus by turning the
syringe to the opposite side, and remains so while going backward a little
over 2 cm., all told. The point of the needle is now in the upper half
of the mandibular sulcus, where we inject the remainder of the solution
(1.5 cc).
To anesthetize the left side, the right hand is used as a guide, and the
syringe is held with the left. A little practice will overcome the difficulty
of working with the left hand.
In a few minutes, upon questioning, the patient will state that his lip
and tongue feel numb — ''swollen, hot, cold, empty, like electricity, with-
out feeling," etc. In almost every case the molars, bicuspids, and the
cuspids are completely anesthetized in from ten to twenty minutes.
Before starting to operate, the mucous membrane is tested by compressing
the gingiva with a pair of pliers on the buccal side of the cuspid and the
tooth one wishes to work upon, and lingually. If, after twenty minutes,
pain is felt in the cuspid region, a second mandibular injection must be
given. In case the buccal mucous membrane in the molar and bicuspid
region only is sensitive, i, e. if supplied by the long buccal nerve, this
part must be desensitized with a horizontal injection in the apical region
of these teeth. In infected cases conductive anesthesia of the long
buccal nerve may be resorted to, injecting beneath the mucous mem-
brane of the cheek below Steno's duct (Williger).
The anastomoses of the inferior dental, lingual, and mental nerves
explain why the middle portion of the lower jaw with the incisor teeth
is not anesthetized. To obtain complete anesthesia of half of the lower
jaw the mental foramen of the opposite side must be injected — ^also
Digitized by V:iOOQIC
AN EPITOME OF CURRENT DENTAL AND MEDICAL LITERATURE 121
lingually at the median line. I have found mandibular anesthesia to
last over two hours.
THE IRRATIONALITY OF BACTERIAL VACCINES IN THE TREATMENT OF
PYORRHEA ALVEOLARIS
By Arthur H. Merritt, D.D.S., New York, N. Y.
The author of this able article sums up his conclusions as follows.
CONCLUSIONS
The irrationality of the use of bacterial vaccines in the treatment of
pyorrheji is proved : —
(i) The exceeding complexity of the bacterial flora of pyorrhea
alveolaris, of which comparatively little is known.
(2) The absolute lack of evidence that any of the organisms present
sustain a causal relation to the disease.
(3) The imreasonableness of expecting a vaccine to affect favorably
a disease when the organisms associated with it are practically beyond the
influence of the antibodies contained in the blood and lymph, as they
are in pyorrheal pockets.
(4) The impossibility, with our present cultural methods and limited
knowledge, of preparing a vaccine which would be at all representative
of the bacteriology of the disease.
(5) The evidence already at hand which indicates that there is no
qualitative difference between the bacteriology of pyorrhea and that of
the normal mouth, and that the difference noted is a quantitative one
only.
(6) The probability that the infection in pyorrhea is purely second-
ary.
(7) The absence of any proof that pyorrhea which has not yielded
to local treatment can be cured by vaccines, or that their use will prevent
recurrence.
(8) The inadvisability of resorting to a complicated and uncertain
form of treatment when simpler and more efficient methods are avail-
able.
(9) The fact that pyorrhea "can be cured by instrumentation, pro-
viding only that it be skilfully done.
When dentists realize that pyorrhea is a preventable disease; that,
in its early stages, it is easily and permanently cured; that only those
cases are hopeless that are long neglected; that no drug or vaccine ever
will, of itself, cure the disease, and that dependence must be placed upon
local treatment, they will have taken the first step toward eliminating,
from the mouths of their patients, the chief of mouth infections.
Digitized by V:iOOQIC
122 THE DENTAL DIGEST
[Dental Items of Interest, January, 1916]
Contents
Exclusive Contributions
The Compressed-Air Obtunder. By Raymond E. Ingalls, D.D.S.
Prosthodontia
Technique for a Simple Bridge, By Herman £. S. Chayes, D.D.S.
Orthodontia
Report of Cases Given Before the Annual Meeting of American Society of Orthodpntists at
Toronto, Ontario. By W. G. Barr, D.D.S.
Reports of Clinics Before the American Society of Orthodontists at Toronto, July, 1914.
Demonstration. By Victor Hugo Jackson, M.A., M.D., D.D.S.
Society Papers
Some Suggestions in Securing Adequate and Uniform Dental Legislation. By Homer C.
Brown, D.D.S.
The Mission of the International Dental Federation. By N. S. Jenkins, D.D.S.
Some Refractories Used in Dentistry. Guy Stillman Millberry, D.D.S.
The Educational Value of Oral Hygiene in the Army. Edwin Payne Tignor, M.D., D.D.S.
The Importance of Mouth Hygiene During Infancy and Early Childhood. By Horace L.
Howe, D.D.S., D.M.D.
[The Dental Summary, December, 1915]
Contents
*Precanccrous Conditions of the Face and Mouth. By John W. Means.
Porcelain-faced Molar Crown. By R. J. Rinehart.
Inlays, Gold and Synthetic Cement Restoration. By S. F. Jocobi.
The Care of the Deciduous Teeth. By I. W. Copeland.
The Business Side of Dentistry. By W. A. Meis.
Modelling Compound-Plaster Impressions. By T. D. Dow.
Prevention and Reproduction. By William Conrad.
Conductive Anesthesia. By George T. Gregg.
Wanted — Better Dentists. By Frederic R. Henshaw.
President's Address. By A. W. McCullough.
Prohibitive Dentistry. By Edwin S. Hulley.
Editorial
Old Time Dentists.
PRECANCEROUS CONDITIONS OF THE FACE AND MOUTH
By John W. Means, D.D.S., M.D., Columbus, Omo
First: Most cancers of the face and oral region have in the be-
ginning passed through a benign stage which is termed precancerous.
Second: One of the most significant things in the study of cancer is
Digitized by V:iOOQIC
AN EPITOME OF CURRENT DENTAL AND MEDICAL LITERATURE 123
the fact that the cells making up this growth in no way differ from the
young cells which are normally elaborated to repair any defect.
Third: There are certain conditions which are commonly benign
but which are very prone to become malignant.
Fourth: We cannot tell which one will become cancer and which
will remain benign; nor can we tell the time at which the change has
occurred.
Fifth: One hundred per cent, cures result from removal in the pre-
cancerous and even the early cancerous stage and a rapid decrease in this
percentage follows procrastination.
Sixth: Removal by surgical means is by far the safest method and
is practically without disfigurement or inconvenience.
In conclusion, then, let me emphasize the thought that the responsi-
bility of the dentist is greater than that of the physician in that
his work brings him in more frequent contact with the lesions of the oral
cavity.
[The Dental Summary, January, 1916]
Contents
The Shoulder Crown. By George S. Hershey.
Gold Inlays as Bridge Abutments. By H. U. Shepherd.
Malplaced and Impacted Third Molars. By L. G. Noel.
Root Canal Filling. By H. L. Werts.
Cast Base Dowel Crowns vs. Ground Joint and Shell Crowns. By J. A. Gardner.
Porcelain- Jacket Crown. By George T. Gregg.
A Plea for More Efficiency and Better Fees. By Charles A. Tavel.
A Sane System of Keeping Burs. By R. C. Simmons.
Crown and Bridge Work. By W. O. Hulick.
Advice to Those About to Wear Artificial Teeth. By D. W. Barker.
Mouth Infection as a Source of Systemic Disease. By Frank B. Walker.
The Sterilization of Dental Instruments. By H. £. Hasseltine.
Distilling Apparatus. By M. M. Brown.
*A Cleft Palate Case. By G. B. Speer.
Mandibular Conductive Anesthesia. By H. F. Koontz.
Report of Committee on Dental Literature. By A. C. Barclay, T. A. Hogan, and J. D.
Whiteman.
Dentistry, in its Progress Through the Century, to Stomatology as a Science. By James
Truman.
A Loose Pin Banded Crown for Upper Lateral Incisors. By B. A. Wright.
A Great National Movement. By W. G. Ebersole.
Some Reminiscences. By W. J. Burger.
Prophylaxis. By Franklin B. Roberts.
Editorial
The Recent Meeting of the Ohio State Dental Society.
Research Institute of the National Dental Association.
Special American Hospital in Paris for Wounds of the Face and Jaws.
Digitized by
Google
124 THE DENTAL DIGEST
A CLEFT PALATE CASE
By Dr. G. B. Speer, Los Angeles, California
Let us say Case No. i, Donald , age 22, came to my office Novem-
ber, 1 9 14; had two rubber vellums, was never able to wear either with
comfort, in either talking or eating; in fact, could talk plainer without-
After examination he followed my directions and went to the Angeles
Hospital. Next morning at eight o'clock, I did a Brophy operation-
He remained in the hospital one week, went home and reported to my
office for removal of lead plates and sutures. He now can talk to strangers
and be understood. In his own words, he says he thinks a school teacher
can now imderstand him and he is going to go to night school. He also
says people do not notice his lip any more and he can whistle, a thing he
always wanted to do but could not.
When I look at this result and I wonder why at this age of human
progress and surgical successes, when we can almost say a man's success
is only limited by his imagination, for we must remember that he who
seeks to discover must first learn to imagine, and the surgeon's hand only
does the work guided by the imagination brain, and all that is necessary
is to look into that mouth and imagine the shape that palate should be.
Then with his hands he constructs out of the tissues already there a
palate, shaping it as it should be, true to nature, and as the potter
modeling his clay has to allow a sufficient excess to allow for the shrinkage,
so we allow for the contractions in the healing, and we have a vellum
worthy of the name; and as I pen these few words, there arises in my
memory a vision of a kindly face, surmounted by gray hair and I can
almost see the kindly eyes and hear the kindly voice of Doctor Brophy,
the originator of the Brophy operation, saying that the time for rubber
velliuns was past years and years ago, and I go further and say there
never was a time for them, for surgery should have preceded them, and
there would never be need or cause for such an article and rubber vellum,
germ-breeding pens would never have been heard of.
Story Building
PROPHYLAXIS*
By Dr. Franklin B. Roberts, Pittsburg, Pa.
A prophylaxis treatment requires time and in order to give the patient
a thorough treatment the fee charged must be in accord with the time
necessary to do the work thoroughly. First of all, remove all deposits.
A mixture of carmi cleanser, glycerine, a drop of essence of peppermint
and, in some cases, a few drops of peroxide I find makes a good paste for
polishing. A little rubber cup made by Young & Co., I find excellent
*Clinic at Odontological Society of W. Pa., 1915.
Digitized by
Google
AN EPITOME OF CURRENT DENTAL AND MEDICAL LITERATURE 125
for use with the engine. This little cup holds the paste, does not cut or
irritate the gum, is soft and not harsh and still removes all stains. The
disclosing solution is used after which all surfaces are gone over with the
hand polisher and wooden points. For deep cusps the little brush used
on the engine is useful. The approximal surfaces can be polished very
thoroughly by using the Kuroris silk ribbon smeared with the paste.
For the high polish the carmi lustro is used, keeping both tooth and lustro
dry. The mouth is now thoroughly syringed with an antiseptic solution
and your time is well spent. This treatment, in my experience, I find
much appreciated by my patients, and should be repeated every two or
three months as the case may be to give the patient the best results.
[The Dental Outlook, January, 1916]
Contents
Original Communications
•Importance of X-Ray Diagnosis in Dentistry. By A. M. Nodine, D.D.S.
Discussion of Dr. Nodine's Paper. By Dr. L. Harris.
The Regents, Dental Education and the Allied Dental Council. By M. William, D.D.S.
Dental College by next October.
Monthly Report of Legislation Committee of the Allied Dental Council.
Editorial
1Q16 — ^A Retrospect and a Forecast.
Letters to the Editor.
Book Review
Simplex Handbook of Dental Materia Medica and Therapeutics.
Students* Department.
Society Activities.
IMPORTANCE OF X-RAY DIAGNOSIS IN DENTISTRY
By Alonzo Milton Nodine, D.D.S.
Oral Surgeon and Dental Consultant ^ French Hospital; Assistant Dental Radiologist, New
York Throaty Nose^ and Lung Hospital
In the field of oral surgery, we find the wrecks and wreckage of care-
less, unsanitary, septic, and sometimes almost criminal dentistry. I
find almost 75 per cent, of the oral surgery I do is the result of bad
dentistry.
When these patients come to the oral surgeon — the Court of Last
Appeal — to save their health and perhaps their life, imagine the responsi-
bility when perhaps the skilled efforts of all others of the healing art have
given no relief. Imagine the carnage that would ensue did the oral
Digitized by
Google
126 THE DENTAL DIGEST
surgeon not first have radiographs of the teeth and jaws, charts, and
surveys of these organs.
It would seem almost impossible for oral surgery to have attained
the high standard of excellence it now has attained if the use of the X-ray
had been denied it.
The limitless conditions in which radiographs serve the oral surgeons
are too numerous to mention. But oral surgery answers that question
too frequently asked, *'What are we going to do with those teeth whose
root canals we cannot fill?"
Oral surgery tells us to fill those canals as far as possible, and then
resect the roots. Oral surgery also answers that other question asked,
**What are we going to do with those teeth which we cannot cure
of a chronic apical abscess? " Disinfect and fill the root canals, and oral
surgery will cut out the granuloma and resect the septic eroded root end.
But only by the frequent and consistent employment of the X-ray
is it possible for the oral surgeon to know how far the canal is filled and
the extent of the apical infection.
[The Texas Dental Journal, December, 1915]
Contents
Original Communications
Prevention of Decay.
Oral Surgery.
Cotton and Explosives.
With Our Contemporaries
A Consideration of Some of the Present Tendencies in Dentistry.
Pellagra.
The Rotary Code of Ethics for Business Men of all Lines.
Personal Observations on the Brophy Plan of Dealing with Complete Clefts of the Lip and
Palate.
Tests of Leaking Amalgam Fillings.
Cavity Toilet Preparations to the Insertion of Synthetic Porcelain.
[The Dental Register, December, 191 5]
Contents
Event and Comment.
Professional Ideals.
The Tooth Brush.
How Should Dentists Advise?
The Human Mouth.
Bibliography.
Index to Volume LXTX.
Digitized by
Google
AN EPITOME OF CURRENT DENTAL AND MEDICAL LITERATURE 12?
[Oral Healthy December, 1915]
Photograph— The late W. T. Stuart, M.D.
♦Centralized Dental Clinics for Children. By Harold DeW. Cross, D.M.D., Boston.
*Localized Dental Clinics for Children. By Wallace Seccombe, D.D.S., Toronto.
Color of the Teeth. By F. H. Orton, D.D.S., Minneapolis.
Interproximal Space and Tooth Form. By Charles E. Woodbury, D.D.S., Council Bluffs.
Fibrous Foodstuffs and Certain Diseases.
Obituary.
Active Service Roll.
Photograph, Dr. Harvey J. Burkhart, Director Rochester Dental Dispensary.
Editorial.
CENTRALIZED DENTAL CLINICS FOR CHILDREN
By Harold DeW. Cross, D.M.D.
{Director^ The Forsyth Dental Infirmary^ Boston)
The Forsyth extends its benefits to all children of Boston and its
suburbs under sixteen years of age whose pecuniary circumstances pre-
clude their securing the services of a private dentist. At the present
time this pecuniary eligibility is based upon maximum of $4 per week
per person in the family. That is, if the family income is $20 for a family
of five, the children of the family become eligible. The number of
children at present cared for is between four and five hundrec^per day.
This number will be gradually increased. A charge is made of five cents
for each visit.
The question of localized clinics was very carefully considered by the
Trustees before the plan of a central clinic was finally adopted. The
local clinics were considered unsatisfactory because (a) It was exceed-
ingly difficult to control the attendance of the operator. They were
liable to come late, to leave early, and possibly not to come at all. Very
strict supervision was found necessary to improve punctual and full
attendance, (b) It was almost impossible to exact an equal standard
of work done in the different clinics. This diflference of standard quickly
became known and clinics were patronized or neglected according to the
standard of work and equipment supplied, (c) A suitable equipment
meant an expensive reduplication of plant. This necessarily occurred
no matter how inadequate the equipment of a given plant might be.
It further meant an idle equipment in many instances for certain hours
of the day. (d) It was found that the trained dental practitioner was
obliged to waste a greater or less part of his time in clerical or nursing
work and by attending to other duties than his strictly professional
services, (e) It was found to be exceedingly difl&cult to regulate the
purchase and cost of supplies and to check their application, (f) And
lastly, it was found that the providing of hygienic and septic quarters
was almost impossible.
Digitized by
Google
12S THB DENTAL DI6BST
LOCALIZED DENTAL CLINICS FOR CHILDREN
By Wallace Seccombe, D.D.S., Toronto
The advantages of Dental Clinics established in the school buildings
may be summarized as follows:
1. The plan is less costly.
2. School discipline gives control of child for treatment as well as
follow-up service.
3. Through the assistance of the school teacher, the daily cleansing
of the mouth by the child may be checked up.
4. In the acquiring of good dental habits of mastication and oral
cleanliness, the child is usually influenced more by the teacher than by
the parent.
5. Complete dental statistics regarding oral conditions are only to
be obtained through the systematic dental examination of children in the
school building.
6. Schools are becoming more and more educating centres for the
conrniimity in which they are situated.
7. Dental operators are under same regulations regarding hours and
discipline as are members of the teaching staff.
Disadvantages of a central clinic as they appear to the writer are:
1. The necessity of children traveling long distances with the con-
sequent expense of transportation. Ten cents for car fares each visit is
a hardship to those who are too poor to pay for regular dental service.
2. In cases of younger children, the inconvenience and expense of
an older person accompanying the child each sitting.
3. Lack of control of the child regarding subsequent sittings and the
impossibility of the daily follow-up.
4. Lack of cooperation between school, home and dental clinic.
In presenting these facts for your consideration, the writer has no
thought of minimizing the possible advantages of a central clinic plan,
but would urge, in view of our experience in Toronto, the many advan-
tages of following the school system which has already been thoroughly
tried across the water and found most practical and efficient.
[New York Medical Journal, December 25, 1915]
DECAYED TEETH AND CANCER
By Alonzo Milton Nodine, D.D.S., New York.
Oral Surgeon and Denial Consultant^ French Hospital; Assistant Dental Radiologist, New
York Throaty Nose, and Lung Hospital
One woman out of seven and one man out of eleven, after the age
of thirty-five years die of cancer in England. Cancer is sixth in the list
Digitized by V:iOOQIC
AN EPITOME OF CURRENT DENTAL AND MEDICAL LITERATURE 129
of diseases that cause death in the United States; there has been an
average of 73,800 deaths from cancer for the last ten years. In New
York State, in 1913, 9,528 deaths were caused by cancer. Cancer
caused over nine times as many deaths as typhoid fever. In 189 1, cancer
caused 3,000 deaths. In twenty years the death rate has increased
166.66 per cent. If this rate continues for another twenty years, the
death rate from cancer will be more than from consumption.
Different estimates indicate that from nine to 26.3 per cent, of all
cancers are found on the tongue. Still others declare that one seventh
to two fifths of all cancers are found in the mouth, tongue, lips, or jaws.
Most of these cancers are on exposed surfaces where they should be
discovered early, operated upon, and cured. Equally significant is the
estimate that one third to one half of all cancers are foimd in the stomach
and duodenum.
Whatever may be the underlying, imdiscovered cause of cancer, there
seems to be no question that the exciting cause is irritation. This irrita-
tion may be caused by chemicals, bums, injuries, or inflammatory dis-
eased conditions. Dynamite is harmless until irritated; and whatever
causes cancer is harmless until irritated. The two regions of the body
most subjected to chronic irritation are the mouth and the stomach.
Cancer is one of the diseases for which modem civilization is held
responsible. Furthermore tooth decay is the most widespread and
prevalent disease for which modem civilization is responsible. Eighty
to ninety-eight per cent, of the school children of the United States have
decayed teeth, and there is little doubt that the same rate prevails with
the adult population. Decayed teeth are due, to a very great extent,
to our modem demineralized, devitamized diet, as well as to haste in
eating, nervous tension, lack of exercise, methods of cooking, and all that
goes with our manner of living.
The particular irritation that is frequently found to cause cancer in
the mouth is the sharp edge of a decayed, wom, misplaced, or tartar
covered tooth. The constant rubbing of the tongue, cheek, or lips over
such a tooth produces an abrasion, an abrasion develops into a sore, and
from a sore it may pass on through various stages to cancer. The
irritation produced by the sharp edge of a broken or poorly fitting plate,
bridge, crown, or filling has caused cancer of the mouth.
Cancerous growths may also spring from the irritated and injured
gum surroimding decayed and broken down teeth. Polyps grow from
irritated tooth pulps. Bony growths result from chronic inflammation
of the covering of tooth roots. Injury to the bony support of teeth by
extraction has resulted in the development of cancerous growths in
these locations.
Digitized by
Google
130 THB DENTAL DIGBST
The chronic irritation of an abscessed tooth, the irritation of decayed
roots, impacted teeth and unerupted teeth, lower the resistance of the
surrounding tissue and invite the development of cancer. Diseased and
uncleansed teeth and gums are sufficiently irritating to produce inflamma-
tion and ulceration of any part of the mouth. It is not unreasonable to
believe that conditions such as these produce cancer of the mouth.
That there are other causes which produce cancer of the mouth and
jaws is unquestioned, but it must not be lost sight of that in such con-
ditions, as have been described lie the possibilities of cancer. In fact,
there are records of a great number of cases which show that cancer has
developed from such conditions. There is the classical example of Gen-
eral Grant.
In New York State, in 1913, 291 deaths occurred from cancer of the
mouth, and in January, 1914, thirty deaths 1 Mayo, Moynihan, and
other surgeons and stomach specialists estimate that 45 to 90 per cent.,
perhaps all cases of cancer of the stomach, originate at the site of an ulcer
of the stomach or duodenum.
Among the most frequent causes of ulcer of the stomach are unmasti-
cated food, too much food, and the constant swallowing of the contents of
a diseased and unclean mouth. Food is not chewed or bolted either from
habit or haste, or because decayed, diseased, deformed, or deficient teeth
make proper chewing difficult, if not impossible.
Large quantities of unchewed food, and the microorganisms and toxins
from diseased, decayed teeth and gums injure the lining of the stomach
either by impaction or stagnation, or else change or disorganize the pro-
duction of the digestive secretions. The coating of the stomach also
becomes infected during these resting periods between meals, when the
hydrochloric acid is not poured into the stomach. The function of the
hydrochloric acid is to neutralize, retard, and destroy the dangerous
microorganisms and their toxins taken in with food.
The abnormal decomposition of food in the stomach due to the inter-
ference with production of the proper amount of hydrochloric acid,
results in the manufacture from food of other acids, such as lactic, acetic,
and butyric. These make the scomach excessively acid. This highly
acid condition is sufficiently irritating to injure the coating of the stomach
and cause gastric ulcer. A large amount of food, or hard unchewed food
entering such a stomach, the churning movements further increase the
irritation already begun by the abnormal acids.
Rosenow has experimentally proved that one particular microorgan-
ism found in unhealthy mouths is capable, when carried by the blood,
of lodging in the wall of the stomach and producing gastric ulcer.
The employment of the X-ray by the dentist assists in the discovery
Digitized by
Google
AN BPITOM£ OF CURRENT DENTAL AND MEDICAL LITERATURE 131
of cancerous and precancerous conditions. This diagnostic agent should
be more frequently employed by physicians and dentists in all cases of
suspicious swellings and enlargements.
A great amount of evidence shows that one of the most certain meas-
ures to prevent cancer, either in the mouth or stomach, is sound, clean
teeth. Lost teeth should be replaced with artificial substitutes so that
food may be properly chewed. In addition, dental defects should be
corrected, decayed teeth should be treated and filled, and all unreclaimable
teeth or roots removed; and all artificial fixtures, such as bridgework or
plates should be made smooth, sanitary, and unirritating. Diseased
gums should be treated to prevent the oozing into the mouth of pus and
poisonous toxins that are found in such foul conditions. Tartar should
be removed from the teeth frequently and thoroughly, and the teeth
cleansed and polished by a dentist or dental nurse. Finally, teeth should
be brushed carefully and thoroughly with a good tooth paste, powder, or
lime water, or lemon juice and water, after eating and upon going to bed.
RONTGEN DISCOVERY AND ITS RECENT DEVELOPMENT AND FUTURE
POSSIBILITIES
By W. D. Coolidge, M. D., Schenectady, N. Y.
Early attempts to show diffraction, refraction, and reflection had
all failed. In 191 2, Lane predicted that if the X-rays were passed
through a crystal, interference effects would be produced just as they
are when ordinary light falls on a Rowland grating. The experiment
was tried by Freidrich and Knipping and proved completely successful.
Bragg later showed that regular reflection of X-rays can be made to
take place from the cleavage surfaces of crystals. A secondary wavelet
spreads out from each atom as a primary wave passes over it.
The work of Laue and Bragg has made it possible to measure the wave
length of the X-rays, and shows them to be a transverse vibration travel-
ing with the velocity of light and with a wave length about one ten
thousandth that of ordinary light.
Moseley and Darwin have found that each element, when placed in
the path of X-rays of sufficiently high penetration, gives off secondary
rays with a wave length characteristic of the particular substance in
question. This serves, not only as a useful method of analysis, but also
as the basis of a logical method for grouping the elements.
FUTURE POSSIBILITIES
I. As our source of X-rays become more and more intense, new
fields of usefulness are opening up The germicidal and sterilizing action
may be commercially useful in connection with food products, etc.
Digitized by
Google
132 THE DENTAL DIGEST
2. They may be useful as an ionizing agent to bring about chemical
reactions.
3. It is now possible to produce cathode rays having a velocity
comparable with that of the most rapidly moving beta rays from the
radioactive substances, and, at the same time, we get X-rays comparable
in penetrating power with the most penetrating gamma rays. We are
also able to produce canal rays which are like the alpha rays, except
that they have lower velocity. These three, together with metallic lead,
constitute the decomposition products of radioactive substances, and it
therefore seems possible that we may some day be able to produce these
radioactive substances synthetically.
4. As we are- now able to put energy into the atom, and as we are
now getting more and more of an insight into the structure of the atom,
it does not seem too much to hope that we shall some day be able to
transmute the elements at will and to store up large quantities of available
energy in small masses.
5. It seems probable that such work as that now being done by the
physicist, on alpha ray scattering and with the X-ray spectrometer, will
lead to much higher efficiency of X-ray production. The desirability of
this is obvious when we think that at present we are able to utilize only
about 0.2 per cent, of the energy which is put into the tube.
This means that if we could raise this efficiency to 100 per cent, and
could suitably direct the rays, we should put into the tube, for say a
stomach plate, not four kilowatts, but only eight watts. In other words,
we should then need in the tube much less energy than we now consume
in the ordinary hand battery flash lamp. I do not mean to give the
impression that the work of the physicist has yet revealed a method
for making the transformation of electrical X-ray energy much more
efficient than it is now; but it does seem probable that with more detailed
knowledge of the mechanism of X-ray production, and this means more
knowledge of the structure of the atom, that we shall some day be able to
help ourselves in this direction.
6. Another dream which should come true some day, is the pro-
duction of a substance capable of making a screen say a thousand times
more sensitive than anything we have now. For relatively little is known
about the mechanism of fluorescence. The whole subject is one of the
greatest interest and undoubtedly stands in very close relation to the
production of secondary X-rays. Seeing, as we now do, the widest
range in the fluorescent power shown by different substances, and
with the mechanism so little understood, it does not seem too
much to hope that the efficiency of this energy transformation may
also be tremendously increased. Most, if not all the energy
Digitized by
Google
K
AN EPITOME OF CURRENT DENTAL AND MEDICAL LITERATURE 133
absorbed by the screen is now transformed, but the amount aosorbed
very small.
%^ 7. Similarly, it does not seem too much to hope that, with our rapidly
^ ising knowledge of characteristic radiations, we shall some day see a
^. raphic plate in which a much larger fraction of the X-ray energy
V- ed with a corresponding increase in speed. From the diagnostic
^v '- ^^ increase in screen and plate sensitiveness is perhaps much
^ desired than is a more powerful or more efficient sources of
^e former would reduce the danger, while the main effect of
.ould be on the pocket book.
With the ability to get, as we now can, characteristic radiations
i definite wave length, the germicidal and physiological actions can be
scientifically studied, with the possibility of finding out whether there is,
for a definite purpose, any specificity of action so that a certain cell
responds more strongly to a certain wave length than to any other.
[New York Medical Journal, January 8, 19 16]
[Presse MidicaL October 25, 191 5]
FRACTURES OF THE INFERIOR MAXILLARY BONE IN MILITARY
PRACTICE
By L. Imbert and P. Real
From experience with a large number of cases the authors have been
led to establish a clinical division into fractures of the anterior group, in
which the line of fracture is somewhere between the canine teeth and the
midline, and fractures of the posterior group, in which it is lateral to the
canine teeth. In the former group the displacement is not sufficient to
cause overlapping of the fragments, the teeth on the side of the fracture
practically retain their normal relationship to the upper teeth, and the
functional result, provided that bony union takes place, is not very bad.
In fractures of the posterior group, on the other hand, a symmetry results
from overlapping of the fragments. The chin is displaced toward the
fractured side and the unaffected side appears more prominent, though
regular in profile. Again, there may be abnormal prominence on the
affected side, due partly to outward displacement of the short fragment,
partly to swelling of the soft tissues, and perhaps partly to the presence
of callus. Behind this prominence, the profile appears flattened, owing
to obliquity of the short fragment and disappearance of the angle of the
jaw from the surface. An important sign of this variety of fracture is
elicited by taking three points on either side of the jaw — the angle,
condyle, and midline — and joining these by imaginary lines.
Digitized by V:iOOQIC
134 THE DENTAL DIGEST
[Medical Record, January 8, 1916]
FECAL INFECTIONS
Drs. W. C. Mayes, W. Wilson, and C. F. Wilson of Memphis, from
their limited experience, drew the following conclusions: (i) That many
diseases, the etiology of which has been obscure, are undoubtedly due to
metastasis or absorption of toxins from a primary focal infection. (2)
We do not believe that we have done our whole duty to a patient by
simply treating the results of a metastatic infection or the symptoms of
toxic absorption. (3) It is absolutely essential to remove the primary
focus when possible or at least overcome the infection in the same in
order to conserve the best body economy. (4) That in the diseases due
to focal infection, if a cure is not effected by the removal of a diseased
focus, or if further metastasis occurs, the focus removed was not the
causative or only causative focus, and a further search should be made
with a view to its removal or cure. (5) That if the focus cannot
be removed, or the infection in the same controlled, for anatomical rea-
sons, often the removal of a diseased tonsil, draining an apical dental
abscess, or accessory nasal sinuses will allow the body economy to so
recuperate that a cure will occur in the original offending focus. (6)
That an innocent appearing tonsil may be the focus, and that the search
for the offending focus is not complete without exhausting every aid of
the laboratory. X-ray, and our own diagnostic ability.
[New York State Journal of Medicine, December, 1915]
CONCERNLXG MOUTH INFECTIONS AS RELATED TO SYSTEMIC DISEASE
By S. Marx White, B.S., M.D.
The problem of eradication of dental foci of infection differs radically
from that presented in the tonsils. In the case of the tonsil, the clinical
evidences of infection may be difficult to secure. One who has sys-
tematically attempted to eradicate focal infections will be often called
upon to insist upon the removal of a fairly innocent-looking pair of tonsils
even in the face of statements by competent nose and throat surgeons
that the tonsils do not appear diseased. We frequently see infection
arising from tonsils which are small, buried and adherent to the pillars
and that show no external sign of inflammation, except possibly a streak
of reddening along the pillar. Such tonsils are as frequently the source
of systemic dissemination as the frankly and evidently inflamed ones.
Where such tonsils exist and where there is no clear evidence of some
other focal infection, the need for tonsillectomy rests more upon whether
there is evidence of systemic infection from some focus than upon the
apparent condition of the tonsil itself. As a result of this attitude we
Digitized by V:iOOQIC
AN EPITOME OF CURRENT DENTAL AND MEDICAL LITERATURE 135
have been frequentiy rewarded by having the pathologist, after removal
of the tonsils, find definite evidences of active inflammation were lacking.
At the present time, we have no more definite clinical criteria of in-
fection in the tonsils than I have outlined above. The demonstration of
streptococci and other organisms on the surface or in the crypts of tonsils
in clinical cases is conclusive only of their existence there. No certain
means of securing uncontaminated cultures from the depth of tonsils,
clinically, is known to the writer.
The case is very different as concerns the teeth and jaws. Here the
dentist can, by proper heat and electricity tests, determine whether
teeth are living ones or not: and the rontgenogram, with proper technic
and experience, can give evidences suggestive of infective processes
about the teeth or anywhere in the tissues of the jaw. The technic and
details of rontgenographic study are matters for the technician, and a
large experience is necessary before a properly qualified opinion can be
expressed.
While the ordinary root abscess is easy of recognition, a great deal
remains to be learned as to the significance of the minor grades of absorp-
tion about the roots. It appears to be true also that in many instances a
focus of infection has been absorbed, and restitution of the tissues of
the alveolar process has occurred, leaving a modified rontgenographic
field. The nature and significance of these modifications still remains
to be worked out.
It would appear to be a simple matter, once abscesses or infected teeth
have been found, to decide what procedure should be adopted; but, on
the one hand, the clinician, anxious to eradicate all foci of infection, de-
mands that infected teeth be extracted: the dentist, anxious to retain
the best occlusal surfaces and masticating mechanism for the patients,
desires to remove only the infected tissues and retain as much as possible
of the tooth. The application to each individual case should be deter-
mined, not by the physician alone, nor by the dentist alone, but by both
together, giving proper consideration to the needs of the patient, the
possibility of the dental procedures to eradicate all infection and still
retain a masticating surface, and finally, the ability of the individual
dental operator involved, so far as securing results is concerned.
Dentists have built up a marvelous mechanical perfection in crown
and bridge work, but at the same time have developed conditions inviting
infection of the alveolar process. Because so often free from local symp-
toms and signs, this infection has remained hidden until brought to light
by the rontgenogram. The infection must be eradicated, but so far as
possible, our patients must be spared the inconvenience and disability of
artificial teeth, and the conservative dentist must learn as far as possible
Digitized by
Google
136 THE DENTAL DIGEST
to eradicate the infection and spare the tooth. In this problem the
physician has a vital interest.
One additional point needs particular attention by the physician.
It is that, if extraction or other operative work is to be employed, care
should be exercised not to overdo or to attack too many foci at one time.
In this field the infections are usually very chronic, and there is no urgent
demand for the immediate eradication of all foci.
Two considerations demand that all foci should not be eradicated at
once. The first is that in case vaccines or bacterins are needed, if all foci
have been eradicated and attempts at cultivation of bacteria have failed
or gone awry, material for culture can no longer be secured.
Secondly, the measures necessary for elimination of the infection fre-
quently stir up and increase the infection at the time and there is con-
siderable danger, particularly in heavily infected individuals, of opening
up many channels of infection, of severe local reactions, sometimes with
necrosis, and frequently of aggravating a multiple joint infection, or
even an endocardial or myocardial involvement. These dangers are real,
and we have had several illustrations of the folly of attempting to eradi-
cate multiple foci at one time. Here again it is necessary that the
physician and dentist confer and take fully into account such possibilities.
DEATHS
Harrison, Dr. H. H., died at Wheeling, W. Va., December 17,
1915, in his 76th year.
Allen, Dr. Chas. H., died December 30th, 1915, at New Milford,
Conn., from the result of an accident. Dr. Allen was bom at Norwalk
on March 8, 1859 and came to New Milford 35 years ago to practise
dentistry. He lived a quiet, forceful life, building up a reputation for
efficiency in his profession. He is very much mourned by his many
friends.
Ervin, J. J. Dr., died December 23rd, 1915, at Elmira, N. Y. Dr.
Ervin was born in Elmira, N. Y., June ist, 1886. He was educated in
the schools of Elmira and graduated from the University of Pennsyl-
vania in 1907.
He was a member of the Elmira Dental Society, Sixth District
Society of New York and the National Dental Society.
Digitized by
Google
FUTURE EVENTS 137
AN INVITATION
The National Dental Association and all ethical dentists will be heartily welcomed by
the profession, the business men and the citizens of Louisville at the twentieth annual con-
vention of this organization, to be held in our city four days conmiencing Tuesday, July 25,
1916.
The First Regiment Armory, in whose 54,000 square feet of floor space the exhibition will
l)e held; the public school building, in whose thirteen commodious rooms the clinics will be
held; Keith's and Macauley's theatres, the auditoriums of the Seelbach and Watterson hotels,
where section meetings will be held, are within a radius of 100 yards, and with the approval of
President Hinman, the most convenient arrangements e\'er provided have been made for the
forthcoming dental convention.
The Kentucky Dental Association will hold its annual meeting, to close Monday, July
24th. The National Association of Dental Examiners will hold its convention, arranging to
close Monday, July 24th. The three Greek letter dental fraternities will hold their annual
conventions Monday July 24th.
Louisville is the ideal convention city of America, convenient of access from all points of
the country, abundant in its hotel accommodations and affording innumerable side attrac-
tions of interest.
The local committees are planning a series of entertainments commensura tewith Ken-
tucky's reputation for hospitality, and the ladies especially who attend the convention will be
guests at innumerable social functions.
Local Conunittee — W. T. Farrar, Chairman, 519 Starks Building, Louisville, Ky.; John
H. Buschemeyer, Mayor of Louisville; Fred W. Keisker, President Louisville Convention
and Publicity League; Thos. J. Smith, President Louisville Board of Trade; Richard II.
Menefee, President Louisville Commercial Club; W. H. Stacy, President Kentucky State
Dental Association; H. B. Tileson, Max M. Ebel, W. M. Randall, R. F. Canine, J. W. Clark,
E. A. R. Torsch, I. H. Harrington, W. E. Grant, Ed. M. Kettig.
FUTURE EVENTS
February 11-12, 1916. — The thirty-third Annual Meeting of the Minnesota State Dental
Association, at the University of Minnesota, Minneapolis.— Max E. Ernst, 614 Lowry
Bldg., St. Paul, Minn., Secretary.
February 16-18, 1916. — The Tenth Annual Clinic, Manufacturers' and Dealers* Exhibit of
the Marquette University Dental Alumni Association, Milwaukee Auditorium, Mil-
waukee, Wis. — V. A. Smith, Secretary,
February 18-19, 1916. — Buffalo Alumni Association, Hotel Iroquois, Buffalo, N. Y. — Grv
M. FiERO, Buffalo, Chairman Executive Committee,
F*ebruary 21-22, 1916. — Golden Jubilee of the Washington University Dental School, at the
Dental School, 29th and Locust Sts., St. Louis, Mo. — H. M. Fisher, Metropolitan Bldg.,
Secrelary.
February 23-24, 1916. — Central Pennsylvania Dental Society, Johnstown, Pa. — C. A.
Matthews, Chairman Exhibit Committee.
March 14, 1916. — Fox River Valley Dental Society, Appleton, Wis. — R. J. Chady, Oshkosh,
Wb., Secretary,
March 20-26, 1916. — TheTri-State Post Graduate Dental Meeting (Missouri, Kansas, Okla-
homa), Kansas City, Mo. — C. L. Lawrence, Enid, Okla., Secretary.
March 23-25, 1916. — Sixth District Dental Society, Binghamton, N. Y., Hotel Bennett. —
William A. Ogden, Chairman Arrangement Committee.
March 25, 1916. — Maryland State Dental Association, Baltimore, Md. — F. F. Drew,
Baltimore, Md., Secretary.
Digitized by
Google
138 THE DENTAL DIGEST
April 4-7, 191 6. — Dental Manufacturers' Club, Chicago, III. Meeting in the Banquet Hall,
Auditorium Hotel. — Chairman ExhiM Committee, A. C. Clark, Grand Crossing, Chicago.
April II, 1916. — Alabama Dental Association, Mobile, Ala.
April 13-15, 1916. — Michigan State Dental Society, Detroit, Michigan. — Clare G. Bates,
Secretary.
April 12-14, 191 6. — West Virginia State Dental Association, Kanawha Hotel, Charleston.
May, 1916. — LAke Erie Dental Association, Erie, Pa. — J. F. Smith, Secretary,
May, 1916. — Susquehanna Dental Association, Scranton, Pa. — Geo. C. Knox, 30 Dime
Bank Bldg., Scranton, Pa., Recording Secretary.
May, 1916. — Indiana State Dental Association, Claypool Hotel, Indianapolis, Ind. — A. R.
Ross, Secretary.
May 2-4, 19 1 6. — Iowa State Dental Society, Des Moines, la. H. A. Elmquist, Des Moines,
la., Chairman of Exhibit.
May 3-5, 1916. — Massachusetts Dental Society, Boston, Mass. — A. H. St. C. Chase
Boston, Mass., Secretary.
May 9-10, 1916. — North Dakota State Dental Association. — A. Hallenberg, Faigo, No.
Dak., Chairman Exhibit Committee.
May 9-12, 1916. — Texas State Dental Association, Dallas, Tex. — W. O. Talbot, Fort
Worth, Tex., Secretary.
May 9-12, 1916. — Illinois State Dental Society, Springfield, Mass. — Henry L. Whipple,
Quincy, Mass., Secretary.
May 1 1-13, 1916.— Dental Society of the State of New York, Hotel Ten Eyck, Albany, N. Y.—
A. P. BuRKHART, 52 Genesee St., Albany, N. Y.., Secretary.
June, 1916. — Florida State Dental Society, Orlando, Fla. — M. C. Izlar, Corresponding
Secretary.
June 1-3, 1916. — Northern Ohio Dental Association, Cleveland, O. — Clarence D. Peck,
Sandusky, O., Secretary.
June 8-10, 1916. — Georgia State Dental Society, Macon, Ga. M. M. Forbes, Candler
Bldg., Atlanta, Ga., Secretary.
June 13-15, 1916. — Connecticut State Dental Association, Hotel Griswold, New London,
Conn. — Elwyn R. Bryant, New Haven, Conn., Secretary.
June 20-22, 1916. — New Hampshire Dental Society, Lake Sunapee, 2^-Nipi Park Lodge, —
Lisbon, N. H,-J. E. Collins, Chairman Exhibit Committee.
June 27-29, 1916. — Pennsylvania State Dental Society, Pittsburgh, Pa. — Luther M.
Weaver, 7103 Woodland Ave., Philadelphia, Pa., Secretary.
June 28-30, 191 6. — North Carolina State Dental Society, Asheville, N. C. — R. M.
Squires, Wake Forest, N. C, Secretary.
July II, 1916. — South Carolina State Dental Association, Chick's Springs, S. C. — Ernest
C. Dye, Greenville, S. C, Secretary.
July 11-13, 1916. — Wisconsin State Dental Society Meeting, Wausau. — Theodore L.
Gilbertson, Secretary.
July 12-15, 1916. — ^New Jersey State Dental Society, Asbury Park, N. J. — ^John C.
Forsyth, Trenton, N. J., Secretary.
July 20-23, 191 6. — American Society of Orthodontists. Address communications to F. M.
Castro, 520 Rose Bldg., Cleveland, Ohio.
July 25-28, 1 9 16. — National Dental Association, ist Regiment Armory, Louisville, Ky. —
Otto U. King, Huntington, Ind., Secretary.
October 18-20, 1916. — Virginia State Dental Association, Richmond, Va. — C. B. Gifford,
Norfolk, Va., Corresponding Secretary.
Digitized by
Google
The Dental Digest
GEORGE WOOD CLAPP, D.D.Sm Editor
Published monthly by The Dentists' Supply Company, Candler Bldg.,
Times Square, 220 West 42d Street, New York, U. S. A., to whom all com-
munications relative to subscriptions, advertising, etc., should be addressed.
Subscription price, including postage, $1.00 per year to all parts of the
United States, Philippines, Guam, Cuba, Porto Rico, Mexico and Hawaiian
Islaiids. To Canada, $1.40. To all other countries, $1.75.
Articles intended for publication and correspondence regarding the same
shoold be addressed Editor Dental Digest, Candler Bldg., Times Square,
220. West 42d Street, New York, N. Y.
The editor and publishers are not responsible for the views of authors ex-
pressed in these pages.
Entered as Second Class Matter, at the Post-Office* at New York City.
Under the Act of Congress, March 3, iSyg. ^'-.
Vol. XXII
MARCH, 1916
No. 3
CLOSED MOUTH IMPRESSIONS*
By Samuel G. Supplee, New York, N. Y.
THIRD PAPER
The more I study impression taking the more I become convinced that
while proper manipulation of modelling compound is not all of impres-
sion taking, there can be no first class impression without proper manip-
ulation of modelling compound.
Furthermore, I feel quite sure that the old method of heating a. pan of
water over a flame and dropping compound into it to be softened is not
only no t the best means of preparing the compound for the impression , but
that it is so far inferior to more recent methods of heating water for this
pur})ose, that only by constant attention to the compound while heating
thus can it be properly softened.
Mr. Supplee has done much to perfect methods of preparing the com-
pound for impression taking as well as to improve the methods for its
use in the mouth. — Editor.
VALUABLE HINTS ON THE USE OF MODELLING COMPOUND
FLOWING AND FLEXIBLE CONDITIONS
To use modelling compound successfully, one must understand what
kind to use and the conditions of its use.
When Perfection Modelling compound is heated in water to between
*This article began in the January, 1916, number.
Digitized by V:iOOQIC
140 THE DENTAL DIGEST
i6o and 170 degrees, it will conform to either soft or hard tissue with
slight pressure, and will not be hot enough to cause discomfort.
This makes it possible to insert into the mouth when itis at a flowing
consistency, and permits the muscles to trim the margins of the denture
without straining the muscles. Pressure must not be applied to the
compound till it has passed from this flowing state into what I call **the
flexible state" when it can be bent without distorting the outline form of
'A satisfactory water heating apparatus
the margins. This is a very important point in taking impressions of
practically all uppers and many lowers.
Most compounds contain too much gum; and as a result do not reach
the flowing state until heated above a temperature suitable for use in the
mouth. They become tough and stringy at lower temperatures.
This toughness has a tendency to improperly displace tissue and may
prevent a satisfactory impression of soft ridges and the buccal and
labial attachments of the upper and lower jaws are easily displaced.
MOVABLE SOFT TISSUE ON THE BUCCAL AND LABL\L BORDER
Surrounding the base of each muscular attachment to the ridge is
movable soft tissue on which pressure can be brought to bear in such way
as to aid in the retention of a denture and increase the comfort of the
patient in masticating.
Digitized by
Google
CLOSfiD MOOta IM»R£SSl6lfS 141
In the average mouth, this movable soft tissue covers an area varying
from J to J of an inch wide over the buccal and labial border, and gener-
ally comes down to within J of an inch or less of what may be called the
occlusal surface of the ridge.
The form of this soft tissue is readily changed by the movement of
the muscles in passing from their rear to their forward position.
Dentures which are to be permanently successful must be trimmed by
the muscles in passing from their rear position to their forward position
while the compound is in a flowing state. The compound must then
be permitted to partially set, so that it will pass from the flowing state
to the flexible state. Finger pressure can be then exerted without caus-
ing the compound to flow. By means of this flnger pressure, the com-
pound can be brought to bear on the movable soft tissue without dis-
placing the muscular attachments or compressing them in a distended
position. In the average case, one minute should elapse after the muscle
trimming before finger pressure should be brought to bear over the buccal
and labial border.
If finger pressure is brought to bear when compound is in a flowing
state, it will force the compound upward and so change the form of the
margin that the bearing will be on the muscle too far from its point of
attachment to the ridge, and will pull or improperly displace the movable
soft tissue. The muscular attachment will respond to this pressure and
will release the pull on the movable soft tissue; as a result the plate will
cease to be in contact with the soft tissue and the muscle will then move
back and forth beneath the edge and will displace the denture.
PRESSURE ON THE MOVABLE SOFT TISSUE SURROUNDING THE BASE OF THE
MUSCULAR ATTACHMENT IS IMPORTANT
If an impression is taken with the mouth closed and pressure is
brought to bear on the movable soft tissue that surrounds the attachment
of the muscle to the ridge (less than yV oi an inch on the muscle itself,)
it will not materially interfere with the free movement of the muscle
When the mouth is opened, there will be a pull on the movable soft tissue
by the muscle that will cause it to seal the edge more firmly, so that the
wider the mouth is opened, the more firmly the joint with the plate will
be sealed by the tissue.
Inasmuch as the mouth is closed or within one quarter of an inch of
being so without biting pressure being applied 75 per cent, or more of the
time, the soft tissue is under light pressure three-quarters of the time
and under heavy pressure when masticating, say one quarter of the
time.
Movable soft tissue will sustain a considerable pressure without the
Digitized by
Google
142 THB DENTAL DIGEST
circulation being affected and will form a contact with the plate at all
times, which is of great benefit to the patient.
The amount of pressure should be sufficient to embed the buccal and
labial border of the impression into the soft tissue. When such pressure
is being exerted during the finishing of the impression the thickness of the
compound and the amount of resistance offered by the compound must be
considered; by referring to illustrations you will note the different for-
mation which can be given to the compound, in the same mouth. The
illustrations show different thicknesses of compound overlaying the
buccal surface of the ridge in the cuspid region, where the greatest
change in the shape of the compound is possible.
A simple experiment to learn what pressure may be applied, is to warm
a small piece of compound about i of an inch thick, and wait until it
has passed into the flexible state. Then hold it between the tip of the
No. I No. 2 No. 3
Modifications of the form of an impression by pressure. Three impressions from one mouth
No. I. Illustrates muscle trimmed impression with no pressure over buccal border.
No. 2. Muscle trimmed with thicker margin but pressure exerted over the buccal bor-
der when the mouth was closed and under biting pressure. Modelling compound was at
the proper consistency and represents the necessary contour for finished denture.
No. 3. Muscle trimmed. Pressure was applied when compound was too soft. The
rim was forced higher than is desired in the denture. The rim is flared outward by the
improperly displaced muscular attachments
thumb and the index finger, and by using the index finger of the other
hand note how much pressure is necessary to embed the compound
slightly into the soft tissue.
TO AVOID TEMPORARY RESULTS
If excess pressure is brought to bear on this tissue, it will often produce
a plate that will be exceedingly tight to start with; but in a short time the
tissue will respond, and the patient will experience a looseness of the
denture without it necessarily dropping from place. This, in some cases,
will cause a loss of confidence, and the psychological effect is such that the
patient will be dissatisfied with what would otherwise have been a very
satisfactory denture. In many cases where the distortion has been very
great, the plate will be absolutely useless.
It is far better to have too light a pressure than too heavy. The
former will improve in fit within a day, while the latter will become less
firm in two or three weeks.
{To be continued)
Digitized by V:iOOQIC
TECHNIC FOR MAKING GOLD CROWNS 143
TECHNIC FOR MAKING GOLD CROWNS FOR POSTERIOR
TEETH IN MOUTH WHERE THE BITE IS VERY CLOSE
By Raymond S. Scovil, D.D.S., Johnstown, N. Y.
After the proper grinding of a tooth for a gold crown, there are three
things that I take into consideration in making the crown.
(i) The relation of the occlusal surface of the crown to the tooth
that strikes it in masticating.
(2) The technic and shape of the crown to the other teeth.
(3) The kind of a crown that is easiest made and still keep the first
two principles that I have mentioned.
In a mouth where the teeth come together naturally and the bite
is light I make a seamless gold crown, the occlusal surface of which can
easily be carved to articulate perfectly with the contending teeth. In
cases where the bite was very heavy and the teeth all worn smooth by
mastication I usually made the two-piece cap and band crown. Now
after considerable experimenting I have been able to make a cast gold
crown that has the appearance of a natural tooth. When I say appear-
ance, I mean the occlusal surface of the crown has the same striking effects
as a natural tooth, the carving of it is the same as natural teeth and the
labial and the lingual sides are the same. In this crown after it has been
poKshed, there can be seen no dividing line between the cap and the band,
and it has all the graceful lines and curves of a natural tooth that a two
piece crown cannot always have.
Recently a man came into my office to have work done. After exam-
ining his teeth I found that he had a lower second molar to be crowned.
The bite was very heavy and all his lower posterior teeth were worn
smooth as a result of inveterate plug tobacco chewing. To this case I
made the cast gold crown which took in actual time not including hard-
ening of plaster, about one-half an hour.
When this crown was finished it could have stood a test against any
seamless or two-piece crown in appearances or masticating properties.
In making this kind of a crown I use the following method. After
the impression has been taken and the model has been mounted upon
the articulator, I take the dentimeter and take a wire measurement of the
tooth while the patient is in the office and then I compare it with the
tooth on the plaster model which I had just mounted. If they agree I
take a fine pointed instrument and carve the gum margin in the usual
way, but a small fraction of an inch deeper. I then make a gold band to
fit the tooth snugly paying careful attention to allow the ends of the
bands to overlap each other when soldering, and also to have the band a
Digitized by
Google
144 THB DBIITAL DIOBST
small fraction of an inch higher than the top of the ground tooth. I then
with the pliers contour the band paying good attention to appearance to
lines on the labial and lingual sides.
I then take some inlay wax and soften it and place it gently on the
top of the tooth with band around and close the bite together giving very
careful attention to the sliding bite as well as the natural bite, straight up
and down. I then separate the bite and begin to carve the wax. In
trimming the wax at the top edge, extend the wax over the band a little.
If you find that the band has not been properly contoured you can
n db
Illus. No. I Ulus. No. 2
remedy this by building it out with wax. Another important thing to
remember is to allow a small scale of wax to extend over the seam, where
the band was soldered, on the outride of the band. Often in casting, the
solder at the joint will run and the joint will be very weak. Now if the
solder should run it would be resoldered in casting.
After the wax has been properly carved and shaped remove the band
with the wax together and cut all excess wax from the inside of the band.
The next and most important step is the investing of this whole
construction. Remember the band and the wax top are invested to-
gether. In investing this construction do not insert the sprue wire in
the top of the occlusal surface (see Illus. No. i). There is a possibility
in casting that solder will run on the outside of the band where it is not
needed, also a possibility of solder running on the inside of the band
making it almost impossible to put on the tooth in the mouth without a
lot of grinding.
Insert the sprue wire between the gold band into the back of the wax
crisp (see Illus. No. 2) and when the gold and solder are run into casting
it will only run where wax was on the band. After this precaution in-
vest in the usual manner and after investment is sufficiently hard and dry
place in heater and burn out wax. Take 22 karat gold and an equal
amount of solder and melt over the sprue hole and when gold is the color
of white heat cast in usual manner. The casting apparatus that I use is
nothing more than a two inch gas pipe filled with wet asbestos; with this
I force the gold into the sprue hole in the casting ring. Any ordinary
casting apparatus will do.
Digitized by V:iOOQIC
RUGAE 145
After the casting is cool and the cast taken out, cut out sprue and
ix>lish. After the crown is polished you will wonder where the dividing
line is. When you put the crown in the mouth you will find that it is the
best fiUingy and the best looking and has the best occlusal surface of any
crown you have made. You will also find out later that it is the best
wearing crown you have ever put in. This method of making of cast gold
holds true of all posterior teeth.
RUGAE
By Victor Lay, D.D.S., Buffalo, N. Y.
It seems that rugae are not only desirable, but quite necessary. It is
said that the tip of the tongue is the most sensitive spot in the human
anatomy. If this is true, then the tongue will aid speech and mastication,
and will feel more at ease, when it is in contact with a close reproduction
of the Almighty-designed surface.
To satisfy yourself, try some experiments on your own palatal surface,
using a smooth wax base Dlate, first — then add some wax rugae and note
the difference.
To be of any service, the rugae must be well forward, beginning with
a central ruga just behind the central teeth, and running distally in the
median line. From this the other rugae radiate, and should imitate the
characteristics of the case at hand.
To produce this effect, the trial plate (teeth set up) is removed from the
model, and the rugae traced onto the palatal surface of the plate with a
hot wax spatula, using one of the pink waxes which cools to the desired
hardness. First produce the central ridge, then imitate the character-
istics appearing on the model. The proper sharpness and accuracy is
obtained by trimming the wax with a sharp knife. Smooth by waving
over the flame. Thin sheet tin is now burnished over the surface, the
plate being on the model. A rubber eraser makes a good burnisher.
Turn up several lugs on the edge of the tin to engage the plaster when
the upper half of the flask is filled. This is not especially new, but may
be of some assistance to someone.
AN AID IN MAKING LARGE PLUMPERS
In making large plumpers, a piece of old vulcanite plate is shaped
up approximately to fill the space in the investment and wrapped in a
hot water sheet. This will prevent porosity.— F. H. B., The Dental
Cosmos.
Digitized by
Google
146 THE DENTAL DIGEST
SUGAR AND ITS EFFECT UPON THE TEETH
By John S. Engs, D.D.S., Oakland, Cal.
As the things with which we are in daily contact are sometimes passed
unobserved, so precautions, which if taken in time would often prevent
disease, are disregarded because of their very commonplaceness and sim-
plicity. **But it is the little things in life that count," and as stick upon
stick and stone upon stone great structures rise, so our bodies grow, cell
by cell being formed from food taken by the growing organism.
Like many other destructive processes which are probably acceler-
ated by the strenuous life of to-day, caries of teeth, or tooth decay, is on
the increase. So universal is its presence, that an English doctor, James
Wheatley, said that measures to check its advance are as much needed
as are measures to check the spread of tuberculosis. He said also, that
consumption of candies and sweets is greater than at any time in history,
a state of things which he disapproves of strongly. Another authority,
J. Hopewell Smith of London, said, parents should not allow children to
indulge in sweetmeats; if they must eat them, then only those made of
pure sugars free from adulterations should be employed; eating them at,
not between meals. (I think if I were to advise as to the kind of sugar
to use in making candy for children, I would not say "pure sugar," be-
cause by that is understood refined sugar, but rather use crude sugar or
cane syrup, for it contains all the food element of the juice of the sugar
cane, which has been found to be capable of furnishing body building
material and sufficient energy to enable the user to subsist on it entirely,
during long periods when engaged at hard manual labor, to the exclusion
of all other food materials. Such sugar will make "panoche" a favorite
mixture with school girls and also drawn candy with which we were all
more or less familiar some years ago.) He expressed it as his opinion,
that the confectionery factories and the wares of street venders should
be placed under State control. England leads the world in the consump-
tion of sugar per capita; the United States comes next. Does not that
offer us food for thought?
SUGAR
When used in reasonable amounts sugar is one of our most valuable
food products. It furnishes both heat for the body and working power
for the muscles. Practical demonstration has shown that it also possesses
stimulating properties which enable us to tide over periods when without
it, the body would succumb to fatigue. But used in excess as it is to-day
all over the world, particularly in England and the United States, it is
Digitized by
Google
SUGAR AND ITS EFFECT UPON THE TEETH 147
beKeved to be detrimental to our health and destructive to the osseous
tissues of the body.
Most of the bad effects of sugar are due to its use in greater amounts
than 3 to 4 ounces per day. It is not locally harmful to the teeth, but is
injurious to them through its action upon the digestive system and meta-
bolism. Like starch, sugar is fattening. When consumed in large quan-
tities the excess is transformed into fat and stored away as reserve
material. While a very active child may bum up a large amount of
carbohydrates to supply energy for his play, a less active one would soon
feel the effect of overindulgence in sugar and sweetmeats, through indi-
gestion and an overloading of the excretory organs.
The chief tissues concerned in the elimination of waste material from
the body are the skin, lungs and air passages (including the mouth and
nose), the kidneys, liver and intestines. Interference with the elimin-
ative powers of the three latter is especially apt to throw extra work on
the skin, lungs and air passages. This gives the sour wine odor in the
breath of diabetics. The peculiar foul odor of the breath and skin in foe-
cal intoxication indicates that the mucous membrane of the mouth, throat,
nose and gums is doing the elimination work that should have been done
by the intestines. The failure of the kidneys to do their proper elimin-
atory work is apt to find expression in the skin, lungs, nose, mouth and
gums. It is a matter of common observation that sugar and sweetened
food is apt to ferment in the stomach and intestines. There are so many
illustrations of the refusal of the system to utilize large amounts of sugar
that we should take warning from them. They show that the consump-
tion of candy can easily be carried too far.
FERMENTATION
Sugar, by which is understood the sugar of commerce, cane sugar, is
one of the carbohydrates and like starch, is transformable into invert-
sugar or glucose which is fermentable. It is open to three different fer-
mentations; the alcoholic, the lactic acid and the acetic acid. The sec-
ond or lactic add is at present of greatest interest to the dentist, because
to it is attributed the destruction of tooth substance that occurs in dental
caries. How far this is true we do not at present know. Some still think
that decay is entirely due to the action of lactic acid; while to others —
myself included — conditions in decayed teeth are continually presenting
themselves that cannot be explained in a satisfactory manner by the
theory of Miller. It is for that reason that I take the liberty to present
this paper in an effort to show why it is believed that an excessive con-
sumption of sugar may bring on, or serve as a contributory cause, of
caries, in an entirely different manner from that which we have been
Digitized by
Google
148 THB DENTAL DIGEST
taught; and that its action may be from the inside and not as we are
generaUy led to believe, entirely from the outside, beginning at the enamel.
ACTION UPON TEETH
Explanations to account for the baneful effect of excessive sugar eating
upon the teeth usually tend to show that ultimately, the oral secretion is
modified or that substances develop in it that attack first the enamel and
then the dentin.
A more recent hypothesis has been offered, however, based on the belief
that faults of nutrition, or faulty metabolism is at the root of the evil;
and that absence of lime in sufficient quantity in our daily food or exces-
sive elimination of the same, from the body is the cause. This condition
is believed to be due to the action of sugar, through its affinity for lime,
or to a general acidosis of the system that may result from many causes,
one of which is the excessive use of sugar, particularly amongst growing
children.
I2TH & Broadway.
(To be cofUimied.)
THE SEPTIC WHEEL-BRUSH
By R. R. C.
Dr. Feldman's indictment of the tooth-brush may be somewhat over-
drawn, but if it is, it is on the safe side. He deserves credit for provoking
discussion of that subject.
There is another brush that should be indicted and its use stopped, and
that is the engine wheel-brush used by some dentists for the purpose of
cleaning burs and broaches.
This rapidly revolving brush cleans (?) from the burs and broaches
the filthy, septic debris that accumulates on them in their use and thor-
oughly distributes it in the air of the office breathed by the dentist and
his patients.
A better way is to sterilize burs that are worth it and use broaches in
but one case. Broaches are not expensive.
Whether a dentist uses this method or the brush-wheel is an indication
of his inteUigence.
Digitized by V:iOOQIC
A BETTER GOLD INLAY 149
A BETTER GOLD INLAY
By W. Goddard Sherman D.D.S., Providence, R. I.
There are numerous methods of constructing gold inlays, each per-
haps possessing one or more points of superiority over another and yet by
reason of some fault during the process, failing to produce a restoration
which is perfect in every respect, especially at the margins.
I consider the margins of gold inlays or any other filling material the
most important factor in effecting a successful operation.
Some of the contributory causes of so-called failures, I believe from ob-
servance, are: — inaccuracy of investment materials by expansion or con-
traction; amount and fineness of gold used in proportion to the size of
the inlay; faulty impressions of cavities for indirect method and the
peculiar manifestations of various kinds of inlay wax used for the direct
method.
K the margins of the average gold fillings and inlays — especially cast
inlays — ^be examined under a strong magnif jdng glass or by the use of a
delicate explorer, a break in the continuity may be detected.
I believe the most accurate results in casting are obtained by the in-
direct method, using amalgam dies.
However, by the following method, which I have employed for some
time, I find it possible to construct inlays surpassing those resulting from
any other method, and also excelling gold fillings without endangering the
enamel margins which spell " Success '' or "Failure."
The following is the method and technic I have formulated.
The cavity should be prepared as per rule for inlays with walls diverg-
ing slightly more than for cast inlays. All enamel margins should be
left sharp and well defined.
The cavity is now to be moistened or oiled and an impression taken
with warmed modeling compound. The compound is then to be chilled
and carefully removed and examined to see if all margins are clearly
recorded in the impression. A bite in wax is then taken and patient
dismissed.
A die of amalgam is made from the impression and by the aid of wax
bite moxmted on an anatomical articulator. From the amalgam die is
taken any number of impressions in modeling compound until accuracy
is assured. A cement die is then made and after being separated from
the impression is invested in either modeling compound or plaster to
strengthen the mass and protect any frail walls.
Gold foil is now to be packed into the cavity by hand pressure only
and tooth restored to desired contour and occlusion.
Digitized by
Google
150 THE DENTAL DIGEST
Filling may be removed from cement die and tried-in in amalgam die
from time to time to govern size, contour, etc.
Great care is to be exercised during packing against margins and quite
a surplus should be used. A flat gold-burnisher is then to be used to aid
in condensing the entire surface, following the rule of burnishing toward
and not away from margins.
When filling is completed the cement die with filling in place is thor-
oughly dried out and then heated in a Bunsen flame until it assumes a
cherry-red color.
The inlay when cool is placed in amalgam die properly seated and
given final trimming, shaping and polishing except at margins where a
fine feather edge is to be left. Inlay is now ready to be inserted for
try-in in the mouth and if found correct (it will be correct if preparation
of cavity and impression were correct) it is removed and preparations
made for cementing. Depending upon the case, undercuts may or may
not be necessary.
A thin, smooth mix of a good inlay cement is used after sterilizing and
drying cavity and inlay is inserted to place with considerable hand pres-
sure. Do not use a malleL While the cement is still soft burnish the
margins. The final finish may be given at this or a subsequent sitting.
Use only very fine abrasives and avoid strips and discs as much as possi-
ble. The burnisher properly used for final finishing is the ideal instru-
ment.
The result will be a gold inlay with margins nearer perfect than I
believe possible to obtain with any other filling material or process. The
gold is harder than a well condensed gold filling, yet soft enough to be
easily manipulated at margins without evil results.
Of the advantages of this method it might be stated that for large res-
torations it is much easier for the patient and less tiresome for the oper-
ator with the added advantage that the inlay is practically finished when
inserted, requiring only a final burnishing of margins.
By the use of this method where large gold filUngs are indicated, more
satisfactory operations will result and much time and energy will be
saved.
171 Westminster St.
A Laboratory Hint. — ^When working with wax in the laboratory,
use a large common school slate for a bench cover. It will catch all
pieces and drops of melted wax and when removed leaves the bench
clean and ready for the next work. Wax spots on a bench may be very
annoying when gold work is being done. — Pacific Dental Gazette.
Digitized by
Google
WRONGFUL DISCHARGE OF DENTIST 151
WRONGFUL DISCHARGE OF DENTIST
(Georgia) One who is employed as a dentist by a dental association
or company, and who is discharged, has the right of electing either of three
remedies: (i) He may bring an immediate action for any special injury
received from the discharge; (2) He may wait until the expiration of the
term for which he was employed, and sue for the entire amount due him
under the contract; or (3) He may treat the contract as rescinded and
seek to recover upon quantum meruit the value of the services actually
performed. Reasonably construed, the present suit is an action to
recover the value of the plaintiff's services for the entire term fixed by
the contract, though it was brought before the expiration of the term;
and a finding for the plaintiff was not supported by the evidence. Proof
that the plaintiff was willing to perform the services for the unexpired
j>art of the term, and that the value of the services as fixed by the contract
amounted to $137.30 would not authorize a recovery of that amount,
where it appeared that the suit was brought prior to the expiration of the
term. (Continental Ass'n v. Lee, 85 S. E. 790.)
LIABILITY OF HOSPITAL FOR NEGLIGENCE IN CARING FOR PATIENTS
{California) Though the case of Wilbur v. Emergency Hospital
decided by the District Court of Appeal of California turned on the
sufficiency of the evidence, and makes no final determination of any very
important legal questions, the facts are quite interesting, and under other
drciunstances might well involve matters of serious legal import. The
action was instituted for recovery of damages for the death of plaintiff's
18 year old son, who, at the time of his decease, was a patient in defen-
dant's hospital. He was suffering from an infected jaw bone and during
the first week of his treatment was under the care of a special nurse, who
devoted all her time to attending him. She prepared a solution of bichlor-
ide of mercury for use in disinfecting the thermometer with which she
took her patient's temperature, and on leaving, at the end of a week,
when it was thought that her services were no longer necessary, she left
the mixture on a chiffonier in the patient's room. Sometime later, one
of the hospital nurses entered the room and saw young Wilbur just getting
back into bed, and was told by him that he had drunk the contents of the
glass on the chiffonier. Antidotes were administered, and the young
man, on being q^estioned, stated that he had no such feelings or symp-
toms as usually attend bichloride of mercury poisoning. He died about
fifteen hours later. The court holds that the evidence is insufficient to
show that his death resulted from swallowing the contents of the glass,
and the circumstances and symptoms were just as consistent with the
Digitized by
Google
152 THE DENTAL DIGEST
theory that the liquid might have been thrown out of the window as
with the drinking of it by deceased, and that his statements to the nurse
were inadmissible as evidence that he actually drank the poison. (Wil-
bur V. Emergency Hospital, 154 Pac. 155.)
MINOR RESPONSIBLE FOR PROFESSIONAL SERVICES
(Louisiana) Where a minor, who has reached a stage of maturity
calculated to deceive a person of ordinary prudence, deceives a dentist
as to his age, and asserts that he is of full age, and induces the dentist
to render him professional services, and accepts the benefits thereof, he
cannot deny that he was of full age, and escape the obligation of the
contract. (Lake v. Perry, 49 So. 569.)
CAN A SERVANT BE CONSIDERED IN THE EMPLOY OF HIS MASTER WHILE
TAKING A HOLIDAY?
(California) A wealthy gentleman by the name of E. W. Cowell died
in March, 191 1, leaving a will which gave to all of the employees of a
certain dental supply company in which he was interested, and who had
been in said employ for twenty years, the sum of $1,000 each, "and to all
who have worked over ten years the sum of $500 each; ... In all
cases these dates are as of January i, 19 11." Frank Tralago, claiming
to be entitled to a portion under this provision, which was opposed partly
on the ground that petitioner was not engaged in the employment of the
designated company on January i, 191 1. It was conceded that this was
a holiday, and petitioner was not actually at work. The evidence went
to show that he had been paid off the day before, and did not again return
to work for some little time after the first of the year. The Supreme
Court of California passing on this question in In re CowelFs Estate,
adjudges it as being rather too technical a construction of the will, as
testator must have known that the day designated was a holiday, and
could hardly have meant to defeat his own purpose of rewarding faith-
ful employees by insertion of a condition which would make this im-
possible. Tralago was held entitled to a $500 share of testator's property.
(In re CoweD's Estate, 149 Pac. 809.)
SALE OF DENTAL FIXTURES
(Georgia) Where, in a contract for the sale of dental office fixtures
and supplies the purchaser agrees to make a partial cash payment and
give notes for the balance, the seller to retain title until the full purchase
money is paid, tender on the terms of the buyer's compliance with the
contract will not have the effect of transferring the title to the purchaser.
If the buyer refuses to make the partial payment and give the notes as
Digitized by
Google
A NEW METHOD OF CONSTRUCTING ARTIFICIAL DENTURES 153
called for by the terms of sale, or to accept any possession or control of
the property, no title passes to him, and the seller's remedy is not for
the purchase price of the chattel, but for the breach of the contract.
(Bridges & Murphy v. McFarland, 85 S. E. 856.)
EXTRACT FROM "A NEW METHOD OF CONSTRUCTING
ARTIFICIAL DENTURES"*
By Doctor J. Allen, 1856
It may be interesting to dentists to-day to read what a prominent dentist pub-
lished in book form, something over a half a century ago, for distribution to the pub-
lic and for the instruction of the public in his particular line of work. Dr. Allen must
have thought that the public knew a great deal about anatomy, because he does
not hesitate to use technical terms freely, either for the purpose of instructing them
or impressing them without instructing. — EDrros.
THE FACE
"Is formed of diflferent muscles, which give it shape and expression.
These muscles rest upon the teeth and alveolar processes, which sustain
them in their proper position.
"When the teeth are lost, and a consequent absorption of the alveolus
takes place, the muscles fall in, or become sunken in a greater or less
degree, according to the temperament of the person. If the lymphatic
predominates, the change will be but slight. If nervous sanguine, it may
be very great.
"There are four points of the face which the mere insertion of teeth
does not always restore, viz: one upon each side, beneath the molar or
cheek bone; and one upon each side of the base of the nose, in a line
toward the front portion of the malar bone.
"The muscles situated upon the sides of the face, and which rest
upon the molar or back teeth, are the Zygomaticus Major, Masseter, and
Buccinator. The loss of the above teeth cause these muscles to fall in.
"The principle muscles which form the front portion of the face
and lips are the Zygomaticus Minor, Levator labii superioris alaeque
nasi and Orbicularis oris.
"These rest upon the front, eye, and Bicuspid teeth;, which, when
lost, allow the muscles to sink in, thereby changing the form and expres-
sion of the mouth.
"The insertion of the front teeth, will, in a great measure bring out
the lips, but there are two muscles in the front portion of the face which
cannot, in many cases, be thus restored to their original position; one
♦Courtesy of C. A. Heller.
Digitized by
Google
154 THE DENTAL DIGEST
is the Zygomaticus minor, which arises from the front part of the malar
bone, and is inserted into the upper lip above the angle of the mouth.
The other is the Levator labii superioris alaeque nasi, which arises from
the nasal process and from the edge of the orbit above the infra-orbital
foramen. It is inserted into the ala nasi or wing of the nose and upp)er
lip.
"The attachments before mentioned, applied to these four points of
the face, beneath the muscles just described, bring out that narrow-
ness and sunken expression about the upper lip, and cheeks, to the
same breadth and fulness which they formerly displayed, thus
restoring the original, pleasing and natural expression. These attach-
ments for restoring the form of the face were first constructed by the
subscriber, some eight years since, and they have been constantly worn
by various persons with ease and comfort ever since that period. They
were first formed of gold plates by being stamped to the requisite form,
and attached to the main plate and teeth. The plates are now covered
with the compound, of which the artificial gum is formed, and which
renders the denture, when thus constructed, far more perfect than the
previous mode.
"The perfection to which this style of work has been brought by the
Author, has induced him to devote his exclusive attention to the con-
struction of full and partial Sets of Teeth; in doing which he pledges
himself to carry out faithfully the principles here set forth."
J. Allen,
No. 30 Bond Street, New York.
Editor Dental Digest:
My little daughter is two and a half years old and has only 10 teeth,
4 upper incisors and 2 molars and only the two lower indsors and 2
molars. She has not been sick, but is nervous, fidgety and will not
sleep all night. She was just 16 months old before she had a tooth.
I can see where the unerupted teeth are, but am at a loss to explain
just why they do not erupt. Her appetite is good but the poor "kid"
cannot properly masticate her food.
Now what can be done to help these teeth erupt? I do not think to
lance the gimis would help, owing to the thickness of gum tissue.
Trusting some one can explain about the delayed eruption of the
teeth of the two and a half year old girl, I am.
Fraternally yours,
M.
Digitized by
Google
FOOD FOR DENTISTS 155
FOOD FOR DENTISTS
By Watson W. Eldridge, M.D., New Rochelle, N. Y.
The author of this paper is particularly well fitted to write upon ail-
ments arising in the alimentary canal. He is a member of the Gastro-en-
terological Clinic of New York University and Bellcvue Medical College,
and comes into contact with many cases of systemic depression arising
from lowered tone and impaired function in the intestines.
He has prepared this paper by my request because I am growing more
and more to realize the importance of maintaining health and efficiency,
and the necessity of physiological exercise to this end. — Editor.
INFLUENCE OF THE HABITS OF THE DENTIST ON THE HEALTH
OF THE ALIMENTARY TRACT
FIRST PAPER
Are you lazy? Do you often feel that to-day's work is too great
an effort to be undertaken? When you are bent over a patient do you
sometimes feel that it would be a relief just to sit down and do nothing?
Do you become restless and want to do something else, anything, except
that which you are doing? Do you enjoy your meals or do you eat
mechanically, or worse still do you often feel that food is repulsive?
Does your night's sleep refresh you or do you arise in the morning feeling
tired and xuifit and xmprepared to cope with the day's work?
ONE SOURCE OF LAZINESS
Such lack of vitality as has been described above may result from
lack of tone in the intestinal tract, from incomplete digestion and the
absorption into the body of intestinal poisons. It may be corrected by
physiological stimulation of the weakened functions.
The normal functioning of the alimentary tract is chiefly dependent
on four things, i. e., muscular tone, digestive secretions, proper position
of the various parts of the tract, and proper food intake. The first three
of these cardinal factors are influenced both separately and collectively
by a number of conditions which are under the control of the individual.
One of the chief of these conditions would seem to be of especial interest
to dentists because of its close connection with their occupation. It is
that of "sedentary habit."
SEDENTARY HABIT, TOXEMIA AND GROUCHES
"Sedentary habit" is present in the history of practically all cases
of fecal stasis or of intestinal toxemia, which come under observation.
The profession of dentistry falls undoubtedly into the class of sedentary
Digitized by
Google _
156 THE DENTAL DIGEST
occupations. The dentist spends all of his producing hours indoors, and
in the larger part of them he is working in an uncomfortable, cramped,
position, over the operating chair or the laboratory table. Fresh air
and exercise form practically no part of his daily routine. His field of
operation is extremely narrow and limited, affording him none of the
opportunity for systemic prophylaxis that comes to the man whose
occupation requires activity in the great outdoors.
** Sedentary habit" once begun, rapidly develops into a vicious circle,
and unless the individual is forewarned and takes pains to combat this
development he will sooner or later drift into that class of pitied speci-
mens known as dyspeptics — hypochondriacs or just plain "grouches."
LIMITED EXERCISE AND THE VICIOUS SPIRAL
Let us follow, for a moment, this vicious circle of which we have
spoken, and watch its development. Let us suppose that practicaDy
all of the time for a week or more the dentist has been indoors, busy over
his operating chair during the larger part of his working hours. The
exerdse which he has taken consisted of the trips between office and
reception room, between home and office which are usually situated in
comparative proximity, movements in the abbreviated radius of the
operating room or laboratory, and an occasional trip to the theatre in
the evening, perhaps made in the stuffy atmosphere of a public convey-
ance. Exerdse of this sort has required little muscular activity. What
there is has been confined to a very limited group of muscles and has
therefore been little better than no exerdse at all. Muscles constitute
about half the body weight and what takes place in them profoundly
influences the remainder of the body organs. Lack of "muscular meta-
bolism," if I may use that expression, naturally follows absence of muscu-
lar exercise, much to the detriment of the rest of the body. As the result
of lack of exerdse the dentist's muscular tone often becomes subnormal
and by its influence on the rest of the body causes a lowering in tone of
the musculature of the intestinal tract. Peristalsis is delayed and weak-
ened as is also the secretion of the digestive juices. The food mass,
which should have been excreted within about seventy hours from the
time of ingestion is still in the intestinal tract. It has long since under-
gone complete or partial digestion and the residue which has no nutritive
value should have been eliminated. Remaining in the large intestine,
it frequently forms a splendid culture media for all sorts of micro-
organisms among which are some of the putrefactive enzymes. These
agents become active and produce chemical changes in the fecal mass
which liberate toxins of various kinds. These are absorbed and sent,
via the drculation, all over the body, affecting the different organs and
Digitized by
Google
FOOD FOR DENTISTS 157
centres in a manner which impairs their functional activity. Digestion
which is already poor through the slowing up of the necessary functional
activities due to lack of exerdse, becomes poorer. The appetite fails or
disappears. The individual becomes easily fatigued and complains of
feeling mentally and physically lazy.
THE WAY OUT
The natural, physiological and most beneficial prophylactic and
corrective of this condition is to take sufficient exercise involving the
whole body, and in fresh air outdoors. This will restore and maintain
good general muscular tone and through that proper tonicity of the
intestinal musculature. A game of tennis or gplf, a "hike" or rowing is
better than any artificial stimulation.
Physical exercise is much more than simply a means of developing
muscular strength. Forty-two per cent, of the body weight is made
up of muscles, and their activity very greatly influences all the rest of
the body organs. Exercise strengthens the heart and blood vessels
which are called on to send more blood to the working muscles. It
deepens the respiration as the lungs are called on for more work. It
improves the appetite and helps the body to get rid of waste products.
It makes the brain clearer and the spirits lighter.
Every one should provide for some form of regular physical exercise
if his work does not require energetic muscular effort. Exercise in the
open air such as walking, not loitering, snow shoeing, skating, riding, and
games of various sorts are ideal ways of keeping the muscular system
and the whole body in good working order.
The exercise must not, however, be too strenuous. It must not be
carried past the point of moderate fatigue and must not be violent in
character. The one extreme of too violent exercise is as undesirable as
the other extreme of too little.
THE BODY AS A FURNACE
The human body must be regarded as in much the same light as the
household furnace. As with the furnace, the fuel must be fed at regular
intervals and it must be of the proper kind, but, of equal importance, is
the timely removal of the ashes, in the proper manner. Let the ashes
remain in the fire bed and the function of the furnace becomes greatly
impaired. The draught is obstructed and the heat of the fire become
progressively less. The situation in the human body, when proper care
is not taken to establish a metabolic equilibrium, becomes quite analagous
to that in the furnace.
It may be argued that cathartics and laxatives can be used as re-
Digitized by
Google _
158 THE DENTAL DIGEST
quired to establish entero-colonic activity, but the answer to this is that
this means affords only temporary relief at best, its final result being the
development of the cathartic habit, which is as bad or worse than the
sedentary habit. A function which should be normal and will respond to
natural causes, cannot be activated indefinitely with artificial stimuli.
Take the right amount of exercise, regularly, and it is not likely you
will have any need for other therapeusis. You will feel better, look
better and be better. The chief causes of your complaints will disappear.
{To be continued)
AN ORIGINAL LETTER TO A DENTIST*
Dr. G. M., III., Oct. 9th 1905.
Dear Sir:
I find of a necesary that I must have some thing did to my teeth, I Can
not say just what, or weather any more than good advice, but providing
I shall make up my mind to have any teeth Extracted, Can you have
yourself provided with a positively, I was going to say painless article.
a gum freezer to make num. Can this be did under any circumstance.
Or is it a say say, saying.
I have of course had teeth extracted at times successfully so far as that
work was did. but so severe pain. As my nerve system has been so
shocked for years this is why I want to know if can be in tirly over come
without taking gas, which I should prefir not to do.
I have had this past week an other dreadful attact of mewralga caused by
catching cold in these teeth, they are no how whole any more, a number
with the crumbling tops intirley gon; and yet they are aparently im-
planted in the jaw generally solid as rocks, this is why I fear and dread
the process, if they was loose & rigley I should not hesitate. I will prob-
ley place in my order for Friday perhaps a bout half past ten. I mean an
order to taulk with you if you are not busey. I am trying to draw the
information nice as I can so there will not be so much swelling and soar-
ness. in this spell it reach such a degree at one tooth Root as to cause an
abcess to form which, came to a head, on the gum in side. You may
conclude of course that I suffered much Pain in this, and to press on the
gum at this place feels as if there was a sack or cusion like, this I hope to
have in better shape By Friday. I do not know sure but think this was
the Eye tooth as we call it.
I wish they was in the Bottom of the Sea any way.
We hope you are all well.
I will try and kep up courage to come and see you any way.
Respfully Yours
*Nwue withheld by request. .
Digitized by V:iOOQIC
mnEff ^viidim
Seest thou a man diligent in business?
He shall stand before kings; he shall not
stand before mean men.
— Proverbs xxli, 29,
THE BUSINESS SIDE OF PROPHYLACTIC AND
RESTORATIVE PRACTICE*
By W. F. Spies, D.D.S., and George Wood Clapp, D.D.S., New York
RESTORATIVE DENTISTRY
THIRD PAPER
By restorative work is here meant all those operations which are
employed in restoring the natural teeth to a condition of masticating
eflSdency, and replacing lost teeth. This includes the treatment and
filling of roots when necessary, the restoration of crowns to proper con-
tact with adjacent teeth and articulation with opposing teeth, either by
means of fillings or porcelain or gold crowns.
It is obvious that in making records for this sort of service, some stan-
dard of excellence must be established, since these operations may be
performed in much less time if the quality of service is not to be con-
sidered. Thus if roots are to be carelessly or hurriedly treated, if inlays
or crowns are not to be contoured to contact and carved to articulating
and masticating efficiency, the cost of each operation will be much less.
It is of little use to estimate on the cost of an inferior quality of service,
since it usually brings the mouth to a worse condition than the first,
within a brief period of time.
A SCHEME FOR COMPUTING COSTS OF RESTORATIVE OPERATIONS
Our experience in the relatively new field of keeping accurate costs
of dental operations has enabled us to devise classifications which we
believe may be adopted by dentists generally to the end that the costs of
operations may be computed by different dentists on a simUar basis.
This permits comparison between different computations to the benefit
of aU.
As in most other activities, we have learned only by experience, and
while we are now computing costs according to this classification, there
are numerous items concerning which we have no data. We hope to be
*This article began in the January 191 6 number.
Digitized by V:iOOQIC
160
THE DENTAL DIGEST
able to offer such data in the future, and in the meantime shall be glad
to have the cooperation of all dentists who desire to see some intelligent
classification for costs generally adopted.
PULP EXTIRPATION AND ROOT FILLING
This class of work presents three general divisions — one in which the
pulp must be removed from a sound tooth that it may be used as an abut-
ment, another in which decay is present without exposure, and a third
in which there is an exposed or putrescent pulp. In cases of inflamed
pulps, palliative treatment may be necessary before devitalization and
post-operative treatment after extirpation. Illustration No. 4 presents
the three conditions of the teeth and it is believed that the form below
it enables the dentist to record the time of each step of the operation.
He can then compute the cost by multiplying the income-hour fee by the
time.
I
7. Number of Cases
8. Average Time
9. Average Cost
Fig. 4. Illustration and fonn
(0
Time Report:
1. Palliative Tr. . . 4. Extirpate ....
2. Appl. As. . . . s. Post Tr
3. Pressure Anes. . 6. Filling
(Incisors, Bicuspids and Molars).
*Our records at present show the following:
No. 8. Devitalizing healthy anterior teeth for abutments, no cavities.
Forty-eight cases from three dentists. Total time for all cases 42 hours,
divided as follows:
Application of Arsenious Acid and pressure anesthesia ....... 12 hours
Removals of pulps and post-operative treatment 17 "
Filling roots 13 "
42 hours
Average time 52 minutes. In each of these cases a cavity was drilled
into the sound tooth structure and Arsenious Acid sealed in from 24 to 48
hours. An exposure of the pulp was then made, pressure anesthesia
applied, the pulp removed. Cost as per table following:
Class I Class U Class III Class IV Class V
Minimum hourly fee $1.45 $2.22 $3.13 $3.94 $4.89
Average cost . . 1.30 1.91 2.60 3.38 4.16
*The numbers given to these operations correspond to the numbers in Chapter 16, "Profit-
able Practice," from which they are taken.
Digitized by
Google
BrSINESS SIDE OF PROPHYLACTIC AlTD RESTORATIVE PRACTICE 161
No. lo. Soothing pulpitis, removing anterior pulps, filling canals.
Forty-one cases from 30 dentists. Average time 45 minutes. Costs as
per table following:
Class I Class II Class III Class IV Class V
Minimum hourly fee $i-45 $2.22 $3- 13 $3-94 4-^9
Average cost . . 1.12 1.63 2.25 2.92 3.50
No. 7. Devitalizing healthy anterior teeth and filling roots, no ex-
posure, pressure anesthesia. Sixty cases from 50 dentists. Average time
30 minutes. The records do not show whether or not there were cavities
in the teeth, and to this extent are indefinite. Costs as per table follow-
ing:
Class I Class U Class III Class IV Class V
Minimum hourly fee $i-45 $2.22 $3 -13 S3 -94 $4-^
Average cost . . . .72 i.ii 1.56 1.97 2.44
No. 9. Removal of exposed, anterior pulps, not inflamed, pressure
anesthesia, filling canals. 59 cases from 50 dentists. Average time 25
minutes. Costs as per table following:
Class I Class II Class III Class IV Qass V
Minimum hourly fee $145 $2.22 $3- 13 $3-94 $4 89
Average cost ... .62 .75 1.25 1.62 2.00
No. II. Treating putrescent anterior canals and filling roots. 53
cases from 46 dentists. Average time i hour and 15 minutes. Average
cost as per table.
Class I Class II Class IH Class IV Class V
Minimum hourly fee $145 $2.22 $3- 13 S3. 94 $4 89
Average cost ... 1.87 2.25 3.75 4.85 6.co
Technic same as No. 8, 20 bicuspids from three dentists.
Application of Arsenious Acid and pressure anesthesia 5 hours
Extirpation and post-operative treatment 12 "
Root filling 9 "
Average time i hour 18 minutes. Cost as per table following:
Class I Class II Class III Class IV Class V
Minimum hourly fee $i-45 $2.22 ^3-^3 $3-94 $4 89
Average cost . . 1.95 2.34 3.90 5.07 6.24
No. 12. Removing healthy bicuspid and molar pulps. 218 cas23
from 60 dentists. Average time 65 minutes. Costs as per table following :
Class I Class II Class III Class IV Class V
Minimum hourly fee $i-45 $2.22 $3-^3 S3 94 $4-^
Average cost . . . 1.62 1.95 3.25 4.22 5.20
Technic same as No. 8, 12 molars from 3 dentists.
Application of Arsenious Acid and pressure anesthesia 7 hours
Extirpation of pulps and post-operative treatment 7 "
Root filling: 8 "
Digitized by V:iOOQIC
162
THE DENTAL DIGEST
Average time i hour and 50 minutes. Cost as per table following :
Class I Class II Class III Class IV Class V
Minimum hourly fee $i-45 $2.22 $3- 13 $3-94 $4-^9
Average cost ... 2.75 4.07 5.50 7.15 8.80
No. 13. Treating putrescent molars and filling roots. 92 cases
from 40 dentists. Averjige time i hour and 45 minutes. Costs as per
table following:
Class I aass IT Class III Class TV Class V
Minimum hourly fee $i-45 $2.22 $3-^3 $3-94 $4-8q
Average cost . . . 2.62 3.85 5.25 7.15 8.80
No. 15. Treating putrescent molars, filling roots, filling crowns with
amalgam. 49 cases from 40 dentists. Average time 2 hours, 10 minutes.
Costs as per table following:
Class I Class II Class III Class IV Chiss V
Minimum hourly fee $i-45 $2.22 %3-iS $3-94 $4-89
Average cost . . . 3.25 3.90 6.50 8.45 10.40
No. 16. Treating putrescent teeth, kind of teeth and care in treat-
ment not specified. 93 cases, 20 dentists. Average time i hour, 25
minutes. Costs as per table following:
Class I Class II Class III Class IV CUss V
Minimum hourly fee $1 ■ 45 $2.22 $3 • 13 S3 ■ 94 $4-89
Average cost . 2.12 3. 11 4.25 5.52 6.80
CLASSIFICATION OF CAVITIES
It is believed advisable to follow the cavity classification of Dr.
Thos. E. Weeks, as given in the American Text-book of Operative Dentistry.
The illustrations are doubtless sufficient without description.
nius. No. 4.
7 8
Fillings in simple cavities
Time Report:
1. Cav. Prep 5. Number of cases
2. Introduction 6. Average time
3. Wax model 7. Average material
4. Laboratory 8. Average cost
(Gold, Foil, Inlay, Alloy, and Cement)
Our records at present show the following:
No. 25. Simple amalgam or cement fillings. 473 cases from
dentists. Average time 25 minutes. Costs as per table following:
65
Digitized by V:iOOQIC
BUSraESS SIDE OF PROPHYLACTIC AND RESTORATIVE PRACTICE 163
Class I
Class II
Class III
Class IV
Class V
Minimum hourly fee
$1.45
$2.22
^3-^3
$3.94
S4.89
Average cost . . .
.62
.89
I-2S
1.62
2.00
The term "simple" is here employed to describe a filling involving
only one surface of a tooth. No records of the care exercised in any of
the steps are available. Three hundred and nineteen of these fillings
were reported as averaging 30 minutes, but 87 were reported by one
dentist as reqiiiring only 10 minutes each, which reduced the general
average. Such variation in records emphasizes the fact that each dentist
should compile his own time records as a basis for his own minimum fees.
No. 30. Simple gold foil fillings. 42 cases from 15 dentists. Aver-
age time 30 minutes. Costs, exclusive of gold, as per following table.
Class I Class II Class III Class IV Class V
Minimum hourly fee $i-45 $2.22 $3- 13 $3-94 $4-89
Average cost ... .72 i.ii 1.56 1.97 2.44
No. 32. Simple gold inlays. 72 cases from 40 dentists. Average
time I hour, 20 minutes. Costs, exclusive of gold, as per table folloi;ring:
Class I Class H Class III Class IV Class V
Minimum hourly fee $i-45 $2.22 $3- 13 $3-94 $4-89
Average cost . 2.00 2.96 4.00 5.20 6.40
II 12
lllus. No. 5. Fillings in compound cavities
Time Report:
1. Cav. Prep 5. Number of cases
2. Introduction 6. Average time
3. Wax model 7. Average Material
4. Laboratory 8. Average cost
(Gold, Foil, Inlay, Alloy, and Cement)
No. 26. Compound amalgam and cement fillings. 161 cases from
60 dentists. Average time 45 minutes. Costs, as per table following.
The term '* compound" is here employed to indicate a filling restoring
two or more surfaces of a tooth.
Class I Qass II Class III Class IV Class V
Minimum hourly fee $145 $2.22 $3- 13 S3 -94 ^4-89
Average cost ... 1.12 1.63 2.25 2.92 3.60
No. 33. Compound geld inlays. 95 cases from 10 dentists. Aver-
age time, I hour 55 minutes. Cost, exclusive of gold, as per table
following.
Digitized by
Google
164 THE DENTAL DIGEST
Class I
Class II
Class III
Class IV
Class V
Minimum hourly fee
$1-45
$2.22
$3- 13
$3-94
^.89
Average cost . . .
2.87
4.22
5.75
7.47
9.20
No. 34. Extensive gold inlays, character not otherwise specified,
16 cases, average time 3 hours, 20 minutes. Costs, exclusive of gold,
as per table following:
Class I aass II Class III Class IV Class V
Minimum hourly fee $i-45 $2.22 tS-^S $3 94 $4 -89
Average cost 5.00 7.40 10. co 13. 00 16. co
No. 35. Finely carved and contoured gold inlays in bicuspids and
molars. 52 cases from one dentist. Average time, 2 hours 45 minutes.
Costs, exclusive of gold as per table following. The gold cost, on the
average, $1.20 per inlay.
Class I Class II Class III
Minimum hourly fee $1-45 $2.22 S3. 13
Average cost ... 4.12 6.07 8.25
To be cofUintied.
Class IV
Class V
S3-94
S4.89
10.72
13 20
Editor Dental Digest:
In the various articles pro and con on dental advertising as pub-
lished in the Digest the past year, one point seems to have been missed.
Suppose it were perfectly legitimate for all dentists to advertise and all
dentists did so, what advantage would one have over another? If one
were not capable of good advertising could he not revert to a professional
advertisement writer and thus do as good advertising as the other fellow,
and all advertising being equal would there not be a large expense thus
added to the dental profession without any advantage to any one party?
Any dentist of good morals, of fair workmenship, attentive to business,
associating with only the best of associates and being conspicuous in
public affairs need not even see wolf tracks within a hundred miles of his
office or home, and a country crossroads may be his place of business.
I might add that a man of good morals is necessarily one clean in person
and office.
Any author of an article written the past year in the Digest com-
plaining of poor business and professional abuse by the other fellow can
diagnose his case in these last few lines and can if he will prescribe for
himself successfully.
One who has been through the mill and did diagnose himself.
R. A. W.
Digitized by
Google
DENTISTRY FROM A FINANCIAL ASPECT 165
DENTISTRY FROM A FINANCIAL ASPECT*
By Percy A. Ash, D.D.S.
Editor "CommonweaUh Dental Review f'' Lecturer and Examiner University of Sydney, Etc,
The dentist who, so to speak, can only do what he was actually taught
while at college will be a partial, if not a complete, failure. There is
probably no vocation which affords so much scope for personal ingenuity
as the mechanical side of dentistry. Think of the many cases presented
to you which are quite different to any you have seen before. Each must
be dealt with entirely in its own merits. Fixed and removable bridges,
vulcanite and metal plates, inlay abutments, and many other methods im-
mediately flit through your mind, and upon your ability to grasp quickly
and intelligently all the alternatives, and eventually decide on the one
which will give the best service, combined with the greatest comfort, will
depend the measure of success which you have in practice.
Dentistry cannot always be carried out on the definite lines set out in
books any more than particular business enterprises can invariably be
built up on the old-fashioned lines. Braddon, again, on this point says,
''A torpid mind, fatal in business, will cling desperately to the established
methods. Hating change, a quick, original mind will always be ready at
any rate to weigh new ideas and to sympathetically appreciate the possi-
bilities of suggested innovations."
There are many details in connection with the conduct of a dental
practice which count for a great deal, and are often neglected, either
through carelessness or the lack of a proper knowledge of the fitness of
things. If a patient telephones for an appointment, and especially if he
asks for a definite time which will suit his convenience, is it not worth while
to personally speak to him after your secretary has taken the message,
and arrange something suitable to him? It gives him an excellent im-
pression of the interest you take in those who consult you. If a friend
sends a patient to you, surely the first thing to do is to thank him for his
kindness; the omission of it is an unpardonable offence. When a new
patient arrives at your rooms, spare a moment to greet him yourself, and,
if he is there by appointment, do not keep him waiting; in any case, if
he is in pain, assure him that, irrespective of inconvenience to yourself,
you will see him within a few minutes and endeavor to make him comfort-
able. Many such small matters might be mentioned which are fre-
quently overlooked. There is no room in the dental profession for the
man who is casual; he must be ever on the alert, and make the most of
every chance. Those who, in other walks of life as well as our own, ex-
^Continued from February Digest.
Digitized by V:iOOQIC
166 THB DENTAL DIGEST
cuse their failures on the ground that business generally is bad and money
scarce, are very often themselves to blame. It is idle to talk of the good
old times which will never return. The world is full of opportunities;
they come knocking at our doors every day. The quicjc and intelligent
man takes hold of them, the pessimist fails to see them, while the drone
does not trouble himself one way or the other.
A feature of great importance in any business or profession is the
ability to properly conduct correspondence. Few things are noticed
more by an educated man than the receipt of a letter badly constructed
and with faulty spelling. Bear in mind that professional men are ex-
pected to be educated to the extent, at least, that they can correctly ex-
press themselves in the language they speak. It is regrettable to have to
admit that there are very many who cannot; and here let me say that
they should fill in all the spare time at their disposal in improving them-
selves in that direction. It is no disgrace that through force of circum-
stances one has not had the advantages of a good education in early life,
but it is unpardonable not to try and make up the deficiency later when
one has the means at his disposal. Surely the ability to properly speak
and capably state one's thoughts on paper is one of the essentials toward
success; it certainly is one of the greatest assets which a man can have who
intends to follow an occupation in life which will bring him in personal
contact with people of refinement, and I presume that all of us aspire to
have that class of people for our patients. It is a constant source of sur-
prise to me why so many comparatively young men seriously lacking in
this way do not spend some of their evenings attending classes of instruc-
tion, or else studying in private with capable tutors.
The point I want to make in mentioning such matters as these is that
very many of us are either wilfully or unconsciously blind to our own short-
comings, and, as a result, we have to suffer. In other words, we fail for
one reason or another to take accurate stock of ourselves. We are ready
enough to pronounce that some other class of business failed because the
manager of it was incompetent; but for our own failures, we lay the blame
anywhere but at our own doors. It is no use attempting to decry the
successful practitioner on the other side of the street by saying that you
are as good a man as he is, and that your professional qualifications were
obtained at schools equal in standard to those where he took his degrees,
for the fact remains that he has succeeded and you have failed. The
thing to do is to ascertain accurately his personal qualities, and then
compare his methods of conducting a practice with your own. Many of
us have attractive points which have never been developed. A good plan
would be to spend some of the money we otherwise waste in seeking the
help of those competent to bring out those latent qualities to the best
Digitized by
Google
DENTISTRY FROM A FINANCIAL ASPECT 167
advantage. Money is given us to make good use of, and surely it can be
put to few better purposes than to assist in the development of char-
acter and those many personal accomplishments essential to success.
Someone has written that the way to succeed is to work hard and
advertise. The necessity for hard work, especially in these exceptional
times of war and distress, when it is gradually becoming a more difficult
problem to make two ends meet, is beyond argument; but the question of
advertising is one that is, and always will be, open to much contention
in so far as professional men are concerned. The style so objectionable is
the hideous signboard or the flaring announcement in public print, more
especially when statements are made not in accordance with fact. It
has been said that the advertising which never shows in a magazine or
on a signboard has more influence on individual lives than all the wonder-
ful public array of words with which we are all so familiar. What
constitutes legitimate advertising within the profession of dentistry is a
matter too large to go into this evening. Each man must decide for
himself, but let him make his decision, if possible, after closely studying
the methods of practitioners who have built up successful practices upon
lines recognized by all around them to be highly ethical.
It may appear to some members of the profession that my remarks so
far have consisted largely of platitudes and preaching. They may say
that they already know all I have remarked, and have found it of no avail.
They may also say that they have read the sayings of philosophers and
commercial magnates, and have found them of no practical use. That is
just the point I wanted to lead up to. If some of us have heard and read
these wise words, uttered in many instances by men who have climbed to
the top of the tree, and have not found them a help on the road to success
in practice, well, then, we should be brave enough to look the whole mat-
ter squarely in the face, admit that we have missed our vocation in life,
and then, with that energy and determination which characterizes the
British race, relinquish dentistry and try our fortunes elsewhere. That
is the sum total of the whole argument, and there is no need to speak fur-
ther upon it.
BANKING ACCOUNTS
No person whose financial transactions amount to any sum worth
mentioning should fail to have a current banking account. Very many
people get their monetary affairs into a state of chaos by keeping their
accoimts in their pockets, so to speak. We shall again take the case of
the careless professional man who does not understand bookkeeping, and
thinks that a bank pass book will be a nuisance to him. Rather than
employ pii accountant, he simply receives and pays out bis money as occa-
Digitized by
Google
168 THB DENTAL DIGEST
sion arises. A patient pays him ten guineas, which he puts into his
pocket. An hour or two later a tradesman calls with a bill for £5-10-6.
He pays it out of the ten guineas he has received, and simply puts the
receipt on a file. He receives and pays money in the same manner month
after month, and so long as he can put his hand in his pocket for what he
wants, he is satisfied that he is keeping on the right side. He probably
notes down on scraps of paper what patients owe him, but keeps no accur-
ate records of his own debts, and therefore frequently receives more or
less of a shock when his creditors present him with statements of their
claims. If he happens to have sufficient money about him when one of
them calls, he will perhaps pay on the spot; if not, he will say to call again.
It is quite certain that a man with a practice or business of any extent
cannot ascertain at short notice how he stands without keeping proper
accounts, and it is also certain that, with the methods of exchange as we
have them now, he cannot conduct his affairs satisfactorily without
keeping an account at a bank. In making this last remark, I have par-
ticularly in mind the system of giving cheques. In Australia, especially,
the custom of settlement by cheque, instead of bank notes or coin of the
realm, has now become so firmly established that one is practically forced
to adopt the system, and the adoption of it necessitates, of course, a bank-
ing account. Whether you pay all your own debts in cash or not, you
will find that the great majority of other business people do not. They
will pay you by cheque, and how are you to get value for those cheques
imless you pass them through your banking account. To be sure, some
few of them may be "open" cheques and be drawn on the local bank, in
which case you or your secretary could obtain cash over the counter;
but by far the greater number will be "crossed" or drawn on a bank
away from the part in which you reside. By an " open " cheque is meant
one that is payable to the bearer of it, that is not crossed, not made
specially payable to any particular person, or restricted in any way; in
other words, a cheque which, if picked up by a stranger, or even stolen, is
payable to the person who presents it, provided, of course, the drawer has
sufficient funds to meet it. Any drawer of a cheque has the right to
request his bank to refuse payment of it if, for instance, it has been stolen
or lost; but, at the same time, it is very questionable if the bank could
be held liable should it pay the same by mistake, assuming that it was
properly drawn; in fact, a bank always requires a written request to stop
payment, and a clause is usually embodied in that request to the effect
that the bank shall be held harmless in the event of the cheque being paid
in error. Also, the instructions to stop payment will not hold good
against any person who has obtained it in good faith and given value for it.
Such a person c^n recover either from the bank or the drawer.
Digitized by
Google
DENTISTRY FROM A FINANCIAL ASPECT 169
If, then, you decide to keep a bank account, it is most important that
all money you receive in connection with your business transactions
passes through that account — not merely the cheques and the larger
amounts in notes and gold, but the humble odd half-crowns also. On
the other hand, let all your paymfenta bb bV cKeq\fft \>f out of some loose
cash which you have on hand, but which *forms part of a previous amount
which you drew '^oiit- for 'sundry duXrent exper.Ses. -As -you 3w5Il be cou'^
stantly disbursing small sums for 6M pufposfe bf aftotH^r", It Ts Veil fo
draw a cheque for, say,»£5»for'|>efty cash, and. g^t'ch'aAj^^'^fdjrnt, to be
paid out as required. If yotrcafre tcrkfcep £f tecdiy <5f 411 the trifles so paid
out, for your own information, well and good, but it will not affect the
balancing of your bank account. Many practitioners (myself included)
do not worry over the details of petty cash. If you keep the amount
for that purpose in your own pocket, you will know that it all has been
rightly disposed of; but if your secretary has charge of it and you have
authorized her to use it, as necessary, without special reference to
you on each occasion, then it would be better for her to keep a record of
all payments, as much for her own satisfaction as for your information.
If you understand little or nothing in regard to keeping and balancing
a proper cash book kept free of charge to yourself. Each customer is
entitled to receive from the bank a pass book, which sets out proper
details of all amounts received and paid away. If, therefore, you pay
all you receive into your account, and draw cheques for all you want,
you can, by merely obtaining your pass book from time to time, ascertain
exactly how you stand; that is to say, you would go through the book,
check the amounts charged against you with those in the butts of your
cheque book, and then, allowing for any cheque unpresented, merely
subtract the one side from the other. It is better, under such cir-
cumstances, to draw your cheques in favor of the persons you pay, or
else the name of the goods you are obtaining instead of in favor of
numbers, as at any time you will then be able to search through your
pass book and ascertain the amount of money you have paid to par-
ticular persons or for specific goods within a given time.
Bear in mind that cheques are not a legal tender, but the custom of
giving them has now become so firmly established that few persons refuse
genuine ones in the ordinary course of business. It would be as well to
say a few words here regarding the use of cheques, particularly in refer-
ence to restricting the negotiability of them, as this is a subject of which
the average man knows comparatively little, and one which he should
fully understand, for he probably adopts the practice in some way or
other very frequently.
A "cheque" may be defined as a draft or order for money payable to
Digitized by
Google
170 THB DENTAL DIGEST
bearer, drawn on a banker; or, to give a definition in legal phraseology,
it is an order upon a bank by a customer requesting the bank to pay a
sum of money on demand to the person named, or to his order, or to the
bearer of the cheque. Note the last few words of this definition very
carefully, as they carina greajid^ pf meaning. The request to the bank
is to pay the amount *td th^p^slW haffted, or to his order, or to the bearer
W* th*e»clie(itfe..*Yo!UJ\Aft ieflierfberithit tbeJjisuaJrcieque form runs,
• • •••• • •• ••«••• ••••••■•• •••••••
*'Pay .*..*..*.*.*.** or* beaief.''" The 'drawer* iS dt'perf^ct liberty to place
in the irfteryejiijifcjBpaDoe a nurnbftr,:tha>najiiO of any person, the words
'* self, "*^^ cash,'' of any omers'fie i^she^aliffj'soTong as he does not strike
out the word '^bearer," the amount is payable to anyone. K the word
"bearer" is struck out and "order" written above it, the payee (that is
the person in whose favor the cheque is drawn) must endorse it. Strictly
speaking, the payee should authorize the bank by written order on the
back of the cheque, to pay the money to a third party, if he wishes that
done; but the custom has become firmly established, and now has the
force of law, for the payee to merely sign his name on the back (i. e., to
endorse). Care must be taken to see that the endorsement corresponds
with the name as written on the front. If, for instance, the cheque
is drawn in favor of James R. Williams, it must be endorsed that way.
It may be that the payee's correct name is John R. Williams (the mistake
being on the part of the drawer), in which case the endorsement should
be "James R. Williams," with the correct signature following under-
neath. In such cases, however, should the endorsement not be exactly
the same as on the front, the bank may, of its own knowledge, be sure
that the cheque has passed into the right hands and may certify to that
effect by writing under the signature "endorsement satisfactory," and
then either pay it if drawn on that office, or else forward it to its destina-
tion. The same conditions apply if the word "bearer" is struck out
without writing "order" above. It is obviously wrong, as is sometimes
done by inexperienced persons, to draw a cheque in favor of a number or
anything in abstract terms, and strike out "bearer," as in such case no
endorsement can be required.
There is one point in connection with the matter which must not be
overlooked. Many people think that if they draw a cheque in favor of a
person and strike out "bearer," it devolves upon the bank to be satisfied
that the endorsement is actually the signature of the payee, thus being
assured that the cheque, at least, had passed through his hands. That is
not so. In New South Wales, at all events, if the endorsement
purports to be the same as on the face, the banker is justified in paying
the cheque; in other words, if the cheque is drawn in favor of E. C.
Forsathe and "£• C. Forsathe" appears on the back of it when presented
Digitized by
Google
"JOSH" COMES BACK 171
for payment, the banker's responsibility ends there. There is con-
siderable protection in the system, however, inasmuch as if anyone has
come by the cheque dishonestly, and writes the payee's name on the
back, he is guilty of forgery, and will be dealt with accordingly.
Should a cheque be stolen the owner will naturally make all the
eflFort he can to recover it; but if it has passed into the hands of an
innocent holder who, in the course of legitimate business, has given value
for it, that holder can, as I have indicated previously, insist upon pay-
ment to himself by the bank, provided the cheque is properly drawn and
otherwise in order when presented. — The Australian Journal of Dentistry,
"JOSH" COMES BACK
Below we reproduce answers we have received to the article which
appeared last month and was signed 'Country Dentist" in which the
Podunk individual says, **What are you going to do when they say
they can get crowns from the other fellow for $5.00? " Read this answer;
it's worth the time.
TO "country dentist"
I am practising in the country and I formerly '^charged them at the
gate." I did a big business; the rough necks and K. M.'s were all for
me and they loudly sang my praises. At the end of each year of this
kind of practising I found that there was very little left for "doc" after
the bills had been paid.
Little "Doc Fist" across the street still puts on his bridge work at
four dollars per, but I have changed my plan of doing business entirely
and I do not have time to worry about the fellow practitioner. There
is not a set fee in this office and all work is priced from the minimum up,
with the accent very decidedly on the up. The first thing that is dis-
cussed when the patient enters the office is the fee, and of course the
service is rendered according to the fee. There are plenty of people in a
country town who will pay a fee that will entitle them to receive real
dental work, but it is a question of salesmanship and enlightening them
along the line of the different methods of doing this work. Use sample
work and with this work use some salesmanship. No sane person would
expect you to place a cast crown for the same price as a plier crown made
in twenty minutes. This holds true of your operative work. Of course
you can "put in a silver filling" and let them slip you a dollar, or you can
discuss this matter with the patient before the operation, and quite likely
you make an amalgam restoration for three dollars. Ignorance of the
Digitized by
Google _
172 THE DENTAL DIGEST
laity causes the trouble with the fee question and it is not so much the
fault of the "fellow across the street." Try it, doctor, it won't do any
harm to tell them that you can give them something better for more
money. Amalgam properly placed and polished is worth more than a
dollar and, honestly, that is about the only reason so much of the amalgam
is not polished and properly finished. Get the flat fee out of your head.
I do not wish to pose as a braggard and do not wish to do any vain-
glorious boasting, so the editor will allow me to sign "Josh."
Curtis, Neb., Jan. i, 1916. — Dr. J. M. Prime, Omaha, Neb. — ^Dear
Doctor: I can not help but comment on what the "Country Dentist"
has to say in regard to fees. He wants to know how to get more than
$5 for a crown, when his competitor, or colleague rather, gets $5. Then,
after he asks how, he turns around and says it can not be done. He
don't care who says so. He reminds me of the Irishman who went to
the circus to see a camel. He had heard about them, but had never
seen one. When he saw it he turned to Pat and said, "Oh, hell, there
ain't no such animal as that."
It evidently seems that this country dentist is in a rut and is destined
to stay there until the cows come home. Some day, though, he may
wake up and some one may be able to show him wherein he is wrong. At
this time, however, it would be a waste of time and space.
Yours truly,
L. A. Chamberlin.
THE COUNTRY DENTIST
My Dear Brother: I do not know who you are, but truly, I want
to know you. Firstly, I shall say, "Let there be light. And there was
light." Secondly, I want you to know that my feeling toward any man
who will endeavor daily to perform an impossibiUty is one of love and
pity. Will you kindly permit me to know you that I may have the
privilege of helping you? There isn't anything in my heart except to be
of service to my fellow brother.
I shall expect to see your name given me in next month's Journal,
after which I shall answer your questions to the best of my ability.
Truly and sincerely,
William L. Shearer.
ANSWER TO country DENTIST
In your reply, Mr. Country Dentist, to Dr. Shearer's article in Prac-
tical Hints in the November Journal, you ask what you would do when a
farmer comes in your office and wants a gold crown for $5 when your
Digitized by
Google
"JOSH" COMES BACK 173
charge for a crown is $6 and another man comes in and wants a plate for
$io when your price is $15.
I will tell you what I would do and what I do do. I would step back
and look Mr. Farmer square in the eye and give him one of the biggest
talks on first class dentistry he ever heard and I would tell him the
difference between a $5 tin can crown made from some faker's die plate
and a real sure enough crown which you have properly fitted around the
gingivae, contoured and carved to occlusion, and nine out of ten he will
pay you your price and be a booster instead of a knocker. The farmer of
to-day is not the farmer of yesterday any more than the dentist of to-day
is the dentist of yesterday, and they are willing to pay for anything if
they are not being held up.
After you give Mr. Farmer this talk, go into your laboratory and heave
your die plates out of the window (using care not to strike the head of
some passerby) and get to work and make good your talk to Mr. Farmer
and show him the difference between your crowns and a $5 crown. If
you don't happen to have one on hand you will usually find one in his
mouth, and that is the best place to compare them.
Why is it a different proposition in the country than in the dty? I'll
tell you. It is because most of us don't want to spend the time to talk
to these people and tell them what they are getting. Most people want
just as good work as they can get and are willing to pay for it if they
think they are getting their money's worth. Give them the best there is
in you and they will stay by you. If you are not giving them as good
service as they can get elsewhere, you had better get busy and prepare
yourself so you can, or some of those young fellows will come in and walk
away with the bacon while you sit in the comer of your office pulling on
an old cob pipe saying, "These young fellows don't know anything."
You just quit knocking and get busy.
If the big men in the cities can do these things, why can't we be big
men in the country? We CAN, and I don't care who says we can't!
A Brother Country Dentist.
Nebraska Denial Journal
lie
'Smokers' Patches" in the Mouth. — ^Landouzy describes these
as consisting of whitish lines or triangular patches extending from the
juncture of the lips to the first molar. These are also known as smoker's
commissural patches. They are found exclusively in syphilitics. To-
bacco is merely the local irritant which causes the patches to develop
in the predisposed. — Presse Medicate, {Medical Record.)
Digitized by
Google
174 THE DENTAL DIGEST
CORRESPONDENCE
Editor Dental Digest:
Will you kindly ask the profession the following questions in your
next issue. I am looking for the honest ones, the sore ones, also the few
I am sorry to say are the fakirs.
Dr. Surgeon Dentist:
1. What is meant by Ethical Dentist?
2. Do you or do you not know any that are Ethical in the real sense
of the word?
3. If you yourself are, then will you show at least one hundred of
your contracts so that your claim may be disproved?
These questions have been generated through the several debates that
appear from time to time in the Digest Advertising vs. Ethics as per-
taining to dentistry.
C. S. L.
REPLIES TO E. S. G.*
Dear Brother E. S. G.:
After glancing at the table of prices you receive for your labor, I can
readily believe they are the "lowest in the state,'' regardless of what state
you are in. I am also forced to believe you when you say it gives you ** no
little trouble." However, I can't sympathize with you for it's all your
own fault and not the "old man's."
I can't account for a town of 7,000 and only three dentists unless it
is because they are so disgusted with 50 cent cleanings and fillings that
they either go somewhere else for their work, or possibly may not have it
done at all. If you are doing fifty cent fillings and cleaning you have
no right to ask more. If not, you have no right to do it for that.
Supposing you were to go into a store and upon being told the price
of an article you told the proprietor you could get it cheaper from Rears
and Sanbrick. Do you think he would at once become a veritable lick-
spittal and get on his knees and beg you to take the goods at no profit just
to keep your patronage? Would you have much respect for him if he
did? No, I think not; yet, that is just what you are doing.
The thing for you to do is to raise the standard of the work and show
them the difference, then you won't have any trouble in getting a fair
price. Do your work your best and charge a fair price. Don't be afraid
to talk to them, but make them see that they get just what they pay for,
be it in dentistry or fish-hooks.
Probably the reason your people don't demand a sanitary office is
•January Digest, page 27.
Digitized by V:iOOQIC
CORRBSPONDENCB 17S
because they never saw one. Let yours be the first and they won't be
slow to reali^ the advantages.
Did you ever hear of a dentist being starved out because his prices
were too high? No, No, Brother! this is what you really hear. They
say, '*He is all-fired high but he does good work and so most of us go to
him."
One more point — about that stock of crowns. Of course there always
will be men who do business that way, and then just across the street
there will be men more conscientious but with no backbone who will try
to compete with them and then mourn their sad plight. You are no bet-
ter than those you consider your competitors, so if you want to get out of
the old man's class all -'ou have to do is to brace up and do better work
and charge for it.
"Waste not your hour, nor in vain pursuit
Of this and that endeavor and dispute;
Better be jocund with the fruitful grape
Than sadden after none, or bitter fruit."
F. L. K.
Editor Dental Digest:
Dr. E. S. G. in the January Digest has my sympathy. We have a
town of less than 7,000 and it supports 8 dentists. He says his is in a
town of 7,000 and 3 dentists. If I was looking for a location I would
endeavor to locate in his town and would take his scale of prices and
multiply them by three just for a starter, for in a town of that size there
are enough that would pay it. Of course a person would have to do a
great deal of talking at the chair, but I would also start a dental educa-
tion campaign. I would ask the other dentists to enter into it, in giving
talks to the school children and the various clubs. If they would not
enter into it, I would go it alone. If patients ever came to me and said
they could get an amalgam filling for 50 per cent, where I charged $1.50,
I would shoot it back at them so quick that it would startle them, that
they can go out and buy a horse for $25 or one for $125, or even $500,
and if they wanted a $25 horse go to him. However, there is no limit to
the number of arguments that can be brought out. E. S. G. is in the
heart of a gold mine and does not know it. If I were he I would go to
my office to-morrow morning (no I would stop and do it now) make a
resolution to make or break, then put a sign in front of my chair some-
thing like this "Ask my prices before having work done and avoid mis-
understandings. Take nothing for granted." This I would do in
justice to those who had been patronizing me and knew the prices I had
been charging. L. L.
Digitized by V:iOOQIC
KA6Ti(AL Hints
[This department is in charge of Dr.
V. C. Smedley, 604 California Bldg.,
Denver, Colo. To avoid unnecessary de-
lay, Hints, Questions, and Answers should
be sent direct to him.]*
Leaky Vulcanizer. — Get a package of Dixon's stove polish: shave
off a teaspoonful and pulverize it. Mix it with equal parts of glycerine
and water. The mixture should be about the consistency of cream.
Paint it on the packing of the vulcanizer with a small brush. A very thin
layer is usually sufficient. Repeat when necessary. — D. W. Barker,
D.D.S., Brooklyn, N. Y.
To Improve Gasoline. — Should gasoline not work well in blow-pipe,
not giving a brush-flame on account of exposure to air, add a little sul-
phuric ether and see the life it gets. — C. M. Bremerman, D.D.S., Cali-
fornia, Mo.
Rugae on Plates. — ^After flask is opened, wax removed, take suit-
able carving instnmients and different sizes of ball burnishers, and carve
rugae on plaster in the half containing teeth. Burnish tin-foil over this,
pack and vulcanize. It takes only a few minutes, and you are well
repaid for your trouble. — H. L. Entriken, D.D.S., Enid, Okla.
To Stop a Leaky Vulcanizer. — Wet rim of cup with water and
sprinkle Wilson's corega freely on same. Close at once. This is my
original way when "necessity was the mother of invention.'' — P. C.
CuRRAN, D.D.S., La Crosse, Wis.
To Clean a Glass Slab of Cement. — I always put my glass slab
when through with (as I have several) in a bowl of water and it remains
therein until the next morning when I take my plate brush and put glass
under water faucet. Cement readily comes off and leaves slab in fine
condition.— Dr. O. B. Shedd, D.D.S., Weedsport, N. Y.
To Make a Two Piece Shell Crown Serve as Bridge Abutment.
— In making two piece shell crowns to serve as bridge abutments, place
seam of band on either mesial or distal surface of root so as to have entire
seam included in solder area of adjacent dummy. — J. E. Ruzicka, D.D.S.,
Plainview, Neb.
*ln order to make this department as live, entertaining and helpful as possible, questions
and answers, as well as hints of a practical nature, are solicited.
Digitized by
Google
PRACTICAL mNTS 177
To Facilitate Waxing Parts of Broken Vulcanite Plates
Together. — Hold parts of broken vulcanite plate in correct apposition
with hands, and with wax spatula in mouth, melt wax and drop with piece
of tooth-pick across break. — N. L. Davies, D.D.S., Seattle, Wash.
To Do Away Altogether with the Very Much-Complained-of
Bellows to a Soldering Outfit. — Get a small rotary air pump and
fasten it to the wall in line with a motor (electric or water), a sewing
machine belt to transmit the power if an electric motor is used. Place
a switch near the blow-pipe and cut in on the line so when it is turned off
the motor can be turned to first speed; to start fire simply turn switch
and apply match. Am using it with a gasoUne generator with absolute
success. — V. C. Stockberger, D.D.S., Syracuse, Ind.
To Grind Natural Teeth Painlessly. — Much of the discomfort
in the use of stones is occasioned by the jarring or vibration of the stone
against the tooth. If the tooth is held firmly in the socket or against
one wall of the socket with the thumb or finger of the left hand wliile
grinding down enamel or opening cavities with stones it will minimize
the discomfort immeasurably. Of course it is understood that all stones
should run smoothly and true and that a stream of water should flow on
them while cutting. If these precautions are taken, any ordinary case
of grinding can be done painlessly. — E. D., The Denial Review,
To Flow Solder Easily. — If the solder is cut into long strips instead
of short pieces, it can be used to better advantage. Heat the case up,
and taking hold of one end of the strip with tweezers, hold the other end
close to the piece to be soldered and direct the flame on it. As it melts
feed it down into the joints or wherever you wish it to flow. In this way
you can see what you are doing, and the solder may be fed into a deep
depression or built up into any desired bulk in precisely the form that is
required. If the solder is not flowing properly, dip the heated end of the
strip in powdered borax, and this will flux it and make it flow smoothly.
—J. W. J., The Dental Review,
Root-Canal Filling Material. — Gutta-percha base plate, weight
one half ounce. Saturated solution of thymol and eucalyptol, measure
one half ounce. Dissolve gutta-percha in chloroform; add thymol and
eucalyptol and mix thoroughly. Allow chloroform to evaporate. Dry
the tooth thoroughly and work the above into the canals with a warm
broach, forcing to apex with a soft piece of rubber and insert gutta-
percha point. — The Pacific Dental Gazette.
A Porcelain Jacket Crown. — This method of making a porcelain
jacket crown is as follows:
Digitized by
Google
178 THE DENTAL DIGEST
First: Remove enamel with stones and burs.
Second: Take impression with ferrule containing modeling com-
position.
Third: Fill impression with cement.
Fourth: Take bite and place cement model in bite and place on
articulator.
Fifth: Burnish i-iooo platinum on cement model of end of tooth.
Sixth: Bake porcelain on platinum matrix. — G. T. Gregg, D.D.S.,
The Dental Summary,
Useful Hints. — In the repair of vulcanite there is no need of waxing
up nor using the press. In the case of a broken plate, grind each side
of the fracture one quarter inch, very thin at the fracture, and pack with
hot spatula, rubbing on small pieces and flask. If a tooth is to be replaced
hold it in place with the lingers, having filed away some of the vulcanite
and pack with hot spatula and flask. — ^L. P. Haskell, The Pacific
Denial Gazette,
To Restrict the Flow of Solder. — In soldiering gold, when it is
desired to restrict the flow to a certain area with a sharp lead pencil
draw a line around the desired area. The solder will not flow past the
line. — The Dental Register.
Strengthening Plaster Models. — For strengthening thin plaster
models so that they can withstand the pressure exerted in flasking, etc.,
light and thin brass wire netting as employed for sieves is cut to suitable
length and breadth and embedded in the plaster while pouring. To
strengthen a bridge abutment on a plaster model, a little roll of wire
netting is inserted as a core when the cast is being poured. — ZahnaerzUiche
Rundschau, The Dental Cosmos,
Separating Modeling Compound Impressions. — In taking model-
ing compound impressions, the compound may easily be separated from
the cast if the impression is painted with a thin solution of shellac before
it is poured. A most perfect impression may be obtained if the compound
be vaselined and held under a stream of hot water for a few seconds just
before the impression is taken. — R. Davis, Dental Review,
To Save Time and the Proper Method to Repair a Plate. — If
the plate is cracked two thirds of the way, hold together until crack is
closed, then with sticky wax and alcohol flame flow sufficient wax over
same and let cool. Then make plaster model, and after it has set remove
plate and break in two. Take fissure bur and cut \ inch of old rubber out
of each side of break, then with same bur cut dovetail grooves on either
side about \ inch apart, then wipe clean with a pledget of cotton and
Digitized by
Google
QUESTIONS AND ANSWERS 179
chloroform. Replace parts of plate on model being sure they are down
where they fit on same. Hold same with left hand and with small pieces
of rubber and a clean hot spatula, keeping spatula hot with alcohol flame,
proceed to work rubber into grooves until even with surface of plate,
then stretch another piece of rubber over groove, smooth to proper thick-
ness, and the whole is ready for flasking. When vulcanized it can b^
finished in a few minutes. I repair all my plates in this manner. A new
gimi front can be put on in the same way. The plate will never break
where the new rubber has been inserted, and if care is exercised the plate
will positively undergo no change to cause a misfit. — ^Alfred Frazer
Kennedy, D.D.S., Walter, Okla.
[I approve absolutely of this method of making repairs. I find it
imnecessary, however, to cut any dovetails, or wipe with chloroform
either when surfaces receiving new rubber are freshly cut and free from
wax or other foreign substance. I prefer also bridging the crack with
pieces of match stick held with sticky wax at each end, putting no wax
directly upon crack, at least until after parts are firmly held in place by
match sticks, permitting one to turn plate over examining crack from
both sides to see that it is correctly closed. In hand packing repairs in
this way, it should be kept in mind that spatula must be as hot as rubber
will stand without burning; when same may be spread on like butter;
provided the right kind of rubber is used. I find Doherty's maroon about
the best that I have tried for this purpose. Black rubber can scarcely be
used for this purpose at all, and some makes of maroon and red are not
much better. V. C. S.]
QUESTIONS AND ANSWERS
Question. — ^Please advise the best way to make a duplicate rubber
plate without taking another impression. (That is, put new red and
pink rubber in plate).— H. L. R., Granton, Wis.
Answer. — Flow as much wax over old plate as you think you will
polish off in finishing new rubber; flask case just as you would if it were
a new case, all wax. After plaster has set thoroughly, heat up very
gradually until case is hot enough to have softened old rubber somewhat,
but not to char it. Now flask may be opened cautiously, and old rubber
taken out; some of the teeth may stick in the rubber, but these can be
easily removed, placed in their respective places, and case packed as
usual. Impression may be taken inside on old plate, excess of impression
material trimmed off, and a re-adaptation secured as above. — V. C. S.
Digitized by
Google
THE BLASTER
in ni fi in T by b. c. forbes
I have kaied more men than all the armies of the world.
I have blighted more homes than all the plagues of history.
I have robbed more children of their birthright than all the thieves
ever born.
I blast careers.
I am the parent of untold poverty.
I breed diseases.
I spread misery wherever I go.
I am oftentimes the inciter of the recklessness that strews the world
with accidents and catastrophes.
I am the most subtle, the most insinuating, the most alluring of
tempters.
I wear the guise of joy — of happiness, of gaiety, of goodfellowship.
I promise pleasures.
I deliver death.
I charm the rich as easily as the p>oor.
I am embraced by the educated as often as by the ignorant.
I speak every language.
I know every clime.
I am as old as history.
I am mightier than kings and emperors.
I have driven rulers from their thrones and overturned dynasties.
I can render the strongest armies imf)otent.
I can sap nations.
I rejoice in bringing dishonor and degradation.
I fill prisons.
I fill insane asylums to overflowing.
I feed hospitals with patients.
I cause more divorces than jealousy can claim.
I am equally f)owerful in undoing women as in wrecking men.
I am welcomed in every class of society.
I am given a place at the tables of the most cultured and the most
exclusive.
I am as eagerly sought after by the poorest and the most ignor-
ant.
Digitized by V:iOOQIC
DIGESTS 181
I am so prized that no function of State, no brilliant social gathering,
no great public dinner is accounted complete without my presence.
I am coveted by many governments for the revenue I yield them.
I consume, however, more wealth than has been spent in building all
the railroads and all the steamships of the world.
I am the costliest inhabitant in every nation.
I and my activities call for the expenditure of unreckonable millions
for prisons and for police forces and courts, for hospitals and for doctors
and for nurses, for insane asylums, for almshouses, for orphanages.
I am, however, beginning to be seen in my real colors.
I am being subjected to scientij5c investigation — and found wanting.
I am falling into moral disrepute.
I can no longer fool the wise.
I have received a body blow from the economic regeneration pre-
cipitated by the war.
I have been discovered to be the arch-foe of progress, of strength, of
eflfort, of eflSdency.
I have been drummed out of one country with beneficent results which
have astounded a world blind to my real character.
I have been curbed in another empire where long I held sway among
the masses — ^men and women — impoverishing them grievously.
I have been barred from nineteen States in this great commonwealth,
but though many believe they foresee my doom from end to end of the
land, I still have many powerful friends whose pockets I fill with my blood
money, but whose lives and families I wreck sooner or later.
I have all the forces of evil on my side, and I shall fight to the last
ditch.
I can prevail so long as I am allowed to wear my mask.
I cannot hope to endure for a day if I be revealed in all my real
hideousness.
I, therefore, summon every enemy of the State, every enemy of the
home, every enemy of family life, every enemy of happiness, every enemy
of progress, every enemy of decency, every enemy of honor, every enemy
of health, every enemy of all that makes life worth while — I summon all
these, my supporters and my worshippers, to enrol themselves under my
banner of skull and cross bones and so battle for me that I, the arch
enemy of mankind and of civilization, shall be victorious over every
agency of righteousness.
Who am I?
I am drink. — North American.
Digitized by
Google
182 THB DENTAL DIGEST
OIL OF TURPENTINE AS A HAEMOSTATIC
By G. Grey Turner, M.S.Durh., F.R.C.S.
A severe case of bleeding after an operation on the elbow resisted all
treatment until the wound was packed with gauze soaked in oil of tur-
pentine. The haemorrhage which previously had been severe and long
continued, at once ceased. The successful use of the oil has been proved
on many other occasions. Its chief sphere of usefulness as a haemostatic
is in cases of secondary haemorrhage. It is of no use until the area to be
treated has been thoroughly freed from blood clot and d6bris; and it is
especially valuable in those cases in which no bleeding point can be
caught, but in which the haemorrhage is nevertheless alarming. The oil
is an antiseptic, and gauze saturated with it keeps wonderfully sweet,
while by its action on the living tissues it gives rise to a slimy pus which
greatly- facilitates the removal of the gauze in the course of forty-eight
hours. The only local inconvenience to which it may give rise is some
blistering of the skin, which need not occur if care is exercised in its
application. Its use is not limited to limbs; for bleeding from a tooth
socket the author knows of nothing that is its equal. Doubt is expressed
as to the value of oil of turpentine as a haemostatic when taken by the
mouth. — Lancet, July 31, 1915.
CONVERSATION
A dentist of my acquaintance who attributes a large measure of his
success to his punctilious attention to the "little things" prides himself
on his ability to taXkjusi enough to his patients.
Not so much as to bore them nor so little as to make the silence
oppressive. Nothing focuses the mind of the patient more strongly
upon the task at hand than sQence. Nothing makes the patient long to
get away from the dentist's oflSce and never see it or the dentist again
more than too much trite talk.
As in most things, the happy mediimi is the perfect virtue.
Talk of pleasant things, of interesting things. Avoid the weather
and other commonplace topics that tend to boredom. Study the inter-
ests of your patients where possible and talk about them. Talk baseball
to the boys, political or business conditions to the men and affairs of local
interest to the women. Be up on current events — a good newspaper
will keep you so — and be able to converse easily on a variety of subjects.
Don't overdo the matter, know when not to talk, and don't ask questions
when your patient's mouth is occupied with hand or instrument.
Greet your patient with a smile, talk to him entertainingly, but not too
much, while he is in the chair and give him a pleasant " good-bye." It pays.
Digitized by V:iOOQIC
DIGESTS 183
INFECTION OF THE HANDS AND FINGERS OF PHYSICIANS
Hddenhain states that during thirty-one years in which he has
practised surgery he has been injured innumerable times and in all cus-
tomary ways, in the course of operation on subjects with sepsis and had
never once become infected. He began after a while to regard himself
as inunime. However, with a rich experience he had never seen a
surgical infection in any colleague or assistant in his own sphere of in-
fluence. Nevertheless he has seen numerous infections in surgeons from
other clinics. The author's only prophylactic after an injury was to
keep the hand and arm in complete rest for twenty-four to forty-eight
hours. Once a colleague came to him for a dressing for an autopsy
woimd, and he ordered immobilization. Returning from an absence
of several days he found the man dead. He had removed the dressing
and very soon after experienced a chill. The author believes firmly that
immobilization for forty-eight hours after these traumatisms would
result in a great reduction of morbidity and mortality among surgeons.
At the last moment the author had a most corroboratory test of his
theories in his own person. After one day's immobilization, following an
injury he felt it his duty to do a certain amoimt of typewriting. He soon
developed a chill and local infection which laid him up for a month and
caused him much misery. He was fortimate in escaping a general
infection. — MUnchener medizinische Wochenschrift {Medical Record)
EXTRAGENITAL CHANCRES
Henry Kennedy Gaskill says it is manifestly impossible to determine
with any degree of accuracy the comparative frequency of extragenital
chancres. The only place in which this could be approximately estimated
would be in the army and navy; here careful statistics of all venereal
diseases are made and the utmost care is taken to prevent their con-
traction. Unless there is a well-maintained correlation between the
several departments that treat syphilis the value of statistics is entirely
lost. As a rule in the histories of cases recorded as having been treated
no reference is made to the situation of the chancres. The writer thinks
we are prone to minimize the danger to which doctors and dentists are
subjected, particularly the latter. With the modem ideas of antisepsis,
the dentists of to-day are sterilizing each instrument after every patient,
but this does not mitigate the risk of personal inoculation! For their
own sakes, dentists should be trained to recognize the appearance of the
mucous patch while in college. At present, to a very large extent, they
obtain their information only from books, and colored plates, not from
living patients. — New York Medical Journal,
Digitized by V:iOOQIC
184 THE DENTAL DIGEST
AN EPITOME OF CURRENT DENTAL AND MEDICAL
LITERATURE
[The Dental Review, February, 1916]
Original Communications
What Shall We Do with Pulpless Teeth. By Thomas B. Hartzell.
•The Treatment of Sinuses of the Head by Means of Bismuth Paste. By Emil G. Beck.
A Consideration of the Problems Involved in Removable Bridge Work. By Karl G.
Rnoche.
President's Address. Our Opportunity. By W. C. M'Wethy.
Proceedings of Societies
Minnesota State Dental Association, Thirty-second Annual Meeting, Held at Minneapolis,
June II, 12, 1915.
Odontological Society of Chicago.
Chicago Dental Society.
Northern Illinois Dental Society, Twenty-eighth Annual Meeting, Held at Freeport, Illinois,
October 20, 21, 1915.
Editorial
The Widening Sphere of Dental Journalism.
Editor's Desk
Answer Your Letters.
THE TREATMENT OF SINUSES OF THE HEAD BY MEANS OF BISMUTH PASTE*
By Emil G. Beck, M. D., Chicago, III.
Practically all sinuses are preceded by abscesses, and therefore a
sinus is nothing else than a shriveled abscess cavity. Many believe that
sinuses, especially rectal, are channels caused by pus burrowing through
narrow spaces from one part of the body to another. I am convinced
that a sinus starts from an infection in either the bony structure or the
parenchymatous organs and after the formation of an abscess, the pus
spreads in the direction of least resistance and opens into either the skin
or the bowels, the urinary bladder, or even the gall-bladder. After
evacuation the cavity gradually shrinks and the sinus forms.
When the abscesses spread in various directions, they form multi-
locular abscesses, sometimes communicating, and at other times not, so
that an astonishing network of sinuses may result. This fact was not
known until it was demonstrated by radiograms of the injected sinuses.
♦Read before the Odontological Society of Chicago, October, iqij;.
Digitized by V:iOOQIC
AN EPITOME OF CURRENT DENTAL AND MEDICAL LITERATURE 185
"The method, as you know, consists of injecting with a glass or metal
syringe a quantity of bismuth paste into an opening of a sinus until one
feels reasonably certain that all ramifications have been filled. The
paste, thus injected, will rapidly congeal and remain in the sinuses long
enough to permit of taking a radiograph.
"A glance at the radiographs in which the network of tortuous sinuses
is clearly shown teaches us its advantages. We can all recall instances
in which such a radiograph would have been of great assistance, and
would have spared many an unfortunate a useless operation.
"Formerly we had to rely upon the probe or the colored fluids as
pathfinders of sinuses, but these served as guides during the operation,
while, only with this new method, are we able to make a correct ana-
tomical diagnosis before an operation is decided upon, and thus we are
able to discriminate between operable and non-operable cases.
"If an operation is decided upon, then the procedure is carried out
with more thoroughness and precision, as we can work with definite
plans before us."
Suppurative sinuses about the jaws very often communicate with the
cavities of the accessory sinuses. Here they are not nearly so extensive
as elsewhere in the body.
Sinuses frequently follow injury, such as gunshot wounds and frac-
tures. Another type is from postoperative infections, after drainage, or
even after clean operation.
Surgical operations for sinuses in the past have proven very un-
satisfactory. In my brother's and my series of some i,8oo cases
treated with bismuth injections, there were some which had lasted many
years and had resisted all surgical treatment; one case had lasted sixty
years, two others forty years. Since the introduction of bismuth paste,
we have been able to separate the operable from the inoperable cases
atnd thus avoid useless operations. The majority of the cases thus
treated heal up without surgical invention. Sixty per cent, have gotten
well.
WHAT SHALL WE DO WITH PULPLESS TEETH?
By Thomas B. Hartzell, M.D., D.M.D.
Research Professor of Mouih Infections^ School of Medicine; Professor of Oral Surgery and
Clinical Pathology, College of Dentistry
First and foremost, is the sterile well-filled tooth a menace? My
answer to that question is most emphatically, no. However, the pulp-
less tooth of the future must be handled by vastly diflferent methods
than the methods of the past to escape condemnation. We, as a pro-
Digitized by V:iOOQIC
186 ,THE DBHTAL DIGEST
fession, will have to give to the care of the pulpless tooth or the tooth to
be devitalized, hours of time, where in the past, we have slurred it over
with little consideration. To accurately remove the pulp, where re-
moval is possible, and fill and protect root canals of a molar, means the
work oftentimes of two or three hours, and to remove root filling from an
imperfectly filled root and purify and re-fiU the canals, may involve
double that expenditure of time. The question which confronts us is,
are we willing to educate our patients to the need of this work and do it
in such a manner as to protect them from serious damage? If we are not,
we must face the issue which is extraction for all teeth in which decay
has exposed the pulp to infection. For that other type of case, in which
bridge work must be placed, we are confronted by the necessity for apply-
ing bridges to our teeth in such a manner that the pulps may be preserved.
I here present for your study a common example in which a crown has
been placed upon a vital tooth, which subsequently died. Some of the
worst cases of infection that it has been my fortune to see have resulted
from the death of teeth which were not devitalized previous to crowning.
The presence or absence of abscess depends upon two things primarily,
the admission of micro-organisms to the tissues and the decrease of
resistance of the individual who has long been sensitized to them by
absorption of their poisons into the circulation from some focal point
or their constant ingestion in the saliva. The recorded cases of the
speaker, of vital teeth showing abscess for two years, and of C. J. Grieves
of Baltimore for one year is fifty vital teeth showing abscess.
During the past winter I have noted thirty cases of teeth which were
bearing crowns, which teeth had subsequently died as the result of in-
fection and extra stress placed upon them in bridges. Infections re-
sulting from death of pulps under bridges always cause the loss of the
bridge, whereas roots from which the pulps have been removed and
properly treated from the standpoint of asepsis, which undergo the mis-
fortune of abscess, frequently may be saved. It seems to me that we
should all endeavor to perfect ourselves in a method or methods which
will lead to few infections through the dental path. In other words,
close the door to infection.
I have record of one hundred and fifty teeth which were found to
contain dead pulps which teeth were perfect as to their structure, pre-
senting no decay or abrasion, the death of the pulps having been produced
by some influence not known to the patient. I have also record of and
can show you a lantern slide of teeth that are apparently abscessed, pre-
senting a clear area of rarefaction about the root ends which contained,
when examined, vital pulps. In fact, I have two recent cases in which
we have large abscesses involving a lateral and central, which in operat-
Digitized by V:iOOQIC
AN EPITOME OF CURREHT DENTAL AND MEDICAL UTERATURE 187
ing to shell out the abscess sack, exposed both the central and lateral
root tips leaving them standing in view, the central containing a living
pulp in seemingly good health with the pulp of normal color and vital.
Therefore, we have evidence to show that the focus of infection about
teeth does not necessarily depend upon destruction of the pulp itself.
The one hundred and fifty devitalized teeth just mentioned doubtless
were devitalized by the admission into the circulation of the pulps of
bacterial emboli. Possibly, as most of them were abscessed, the abscess
commenced in the apex of the socket, because the apex of the socket is
the most likely place for bacterial emboli to lodge whether the tooth be
vital or non-vital. The anatomical relations favor the deposition of
bacterial emboli in the apices of the tooth's socket because some of the
vessels there are terminal. If bacterial emboli lodge and multiply in the
terminal vessels, which supply the tissues about a root end, the result is
abscess whether the tooth be vital or pulpless.
[The Dental Cosmos, February, 1916]
Original Communications
Mottled Teeth: An Endemic Developmental Imperfection of the Enamel of the Teeth
Heretofore Unknown in the Literature of Dentistry. By G. V. Black, M.D., D.D.S.
Sc.D., LL.D., and Frederick S. McKay, D.D.S.
The Treatment of Pyorrhea Alveolaris with Emetin Hydrochlorid. By Lionel SherrifiF,
Suigical Dentist.
♦Ankylosis of the Jaw. By John B. Murphy, M.D., F.R.C.S. (Eng.), F.A.C.S., and PhQip
H. Kreuscher, A.M., M.D.
•The Mercurial Treatment of Pyorrhea Alveolaris. By C. S. Copeland, D.D.S.
•A Further Study of Some Etiolo^ cal Factors of Malocclusion. By Milo Helhnan, D.D.S.
Some Considerations for the Dental Practitioner in Employing Vaccine Treatment. By
George C. KQsel, M.D., D.D.S.
The Uses and Advantages of X-rays as an Aid to Diagnosis. By Charles A. Clark, L.D.S.I.
A Comparison of Inkys with Fillings. By H. W. C. Badecker, B.S., D.D.S., M.D.
ANKYLOSIS OF THE JAW
By John B. Muhfhy, M.D., F.R.C.S. (Enc.) FJV.C.S.,
AND
Philip H. Kreuschek, A.M., M.D., Chicago
This analysis of twenty-three cases covers the four varieties of anky-
losis that occur in or about the temporo-mandibular articulation, viz. :
(a) Intra-articular bony ankylosis.
(b) Intra-articular fibrous ankylosis.
(c) Sub-zygomatic cicatricial fixations.
(d) Inter-alveolar buccal fixations.
The technique for the formation of new joints may be divided into
Digitized by V:iOOQIC ^
188 THE DENTAL DIGEST
seven diflferent stages, each of which has been initiated or created by the
work of a single individual and followed by the succeeding schools. These
stages are:
(i) The formation of flail joints, especially of the shoulder and
elbow (Langenbeck, Oilier, Julius Wolff, and others). These were de-
sired sequences following resections of tuberculous and syphilitic joints,
and joints destroyed by pus infections.
(2) The restoration of motion in a bony ankylosed joint by the inter-
position of muscle and fibrous tissue between the separated ends at the
joint, as in the mandible (Helferich, 1893).
(3) False joints developing after bone operations in the neighborhood
of joints (Lorenz).
(4) The transplantation of pedicled flaps of fascia and fat and capsule
with the production of movable sliding serous surface joints (Murphy,
1902) in the mandible, shoulder, elbow, wrist, finger, hip, knee, ankle, and
toe articulations.
(5) The homo-transplantation of the articular ends and surfaces of
bone (Lexer, 1906), particularly in the knee.
(6) The transplantation of detached fat and fascia (Lexer).
(7) The interposition of foreign material to make the joint, from
Pean's metallic joint down to Kraske, Baumgarten, Roser, and Baer's
hetero-visceral implantations.
The fourth stage, as outlined by Murphy, is a transplantation of
pedicled flaps of fascia with fat and capsule. It is the one which has
given practically one hundred per cent, movable joints, and is applicable
in nearly every joint of the body where the peri-articular tissues have
not been destroyed by some previous operative procedure or destructive
pathologic process. It would be gratifying if the free fascia and fat
transplantation of Lexer, mentioned under stage 6, would with future
experience sustain the good results which its originator predicts for it.
Judging from our experience we believe that it will not meet the require-
ments in weight-bearing joints.
The insertion of foreign material or heteroplasties are doomed to
disappear from this field of work, as experience has shown that foreign
absorbable material, if aseptic, must eventually be supplanted by con-
nective tissue; while a flexible flail joint may result, a movable sliding
joint cannot be obtained from such an interposition. The foreign ma-
terial, when it is septic, is always a detriment rather than an aid in the
formation of a movable joint. Non-absorbable metal materials can
be serviceable only under very few favorable conditions. (See Chlum-
aky's experiments.)
In Murphy's work on the arthroplasties of the temporo-mandibular
Digitized by V:iOOQIC
AN EPITOMB OF CURRENT DENTAL AND MEDICAL LITERATURE 189
articulation the cases may be divided as stated above, viz: (a) The
intra-articular bony ankylosis (true ankylosis); (b) the intra-articular
fibrous ankylosis; (c) sub-zygoma tic cicatricial fixations, and (d) inter-
alveolar buccal fixations.
Under c belong the fixations in the sub-zygomatic zone, resulting in
scar tissue which binds the coronoid process to the cranium. Under d
belong the cicatricial fixations due to sloughing of muscle and mucosa
in the mouth or cheek.
ROUTES OF INVASION
The four routes of infection invasion into or surrounding the temporo-
mandibular articulation may be given thus:
First, and most frequent: An extension of the suppuration from the
middle ear (cases No. i. No. 4, No. 7).
Second: A mandibular osteitis or osteomyelitis extending to the
glenoid cavity.
Third: A metastasis from foci of infection within the mouth or else-
where in the body (cases No. 2, No. 3, No. 9, No. 10, No. 19, No. 20),
or part of a general metastatic arthritis (case No. 11).
Fourth: It may result from a transmitted trauma from the tip of
the chin to the articulation, giving a traumatic osseous fibrous arthritis
(cases No. 6, No. 14, No. 15, No. 17).
The glenoid fossa alone may be involved in the ankylosis, or the bony
bridge may extend forward to include the zygomatic and coronoid pro-
cesses.
The most common cause of the ankylosis is a middle-ear suppuration
in which the infection may pass in five different directions: First, back-
ward into the mastoid; second, through the posterior wall of the petrous
bone into the posterior cerebral fossa; third, it may penetrate the attic
of the ear and form an abscess in the middle cerebral fossa or rupture
externally just above the tip of the ear; fourth, it may burrow forward
and rupture into the glenoid cavity or pass over the base of the zygomatic
process into the mandibular articulation; fifth, it may burrow forward
into the sub-zygomatic temporal muscle and produce an extensive
phlegmonous myositis, with subsequent cicatricial contraction binding
the coronoid process and inhibiting mandibular motion.
In the cases of para-articular fixation the condition is usually caused
by (i) a sloughing of the mucosa of the cheek, such as follows typhoid
fever, scarlet fever, measles, infection of the alveolar processes; (2) in-
fection of the scalp or cranium or infections from the mouth into the
temporo-mandibular fossa which produce a destruction of the fascia and
temporal muscle.
Digitized by
Google
190 THS DENTAL DIGEST
A FURTHER STUDY OF SOME ETIOLOGICAL FACTORS OF MALOCCLUSION
By Milo Hellman, D.D.S., New York, N. Y.
(Read before the Eastern Association of Graduates of tke Angle School of Orthodontia, at Us
annual meeting, New York, M-^ly 20, XQ15)
RiSUMfi
Dr. Hellman sums up the evidence which he brings forth in this
article as follows:
(i) That malocclusion of the teeth is found to be intimately related
to conditions that interfere with normal breast-feeding. Of 134 cases
examined, 83 per cent, were found to be bottle-fed.
(2) That results obtained by experimentation demonstrate that
definite anomalies in the teeth and jaws may be produced in lower
mammals by artificial disturbances created in the internal secretory
glands.
(3) That a close relationship is found to exist between malocclusion
of the teeth in the human being and such anomalies of the denture as are
produced by experimental disturbances of the internal secretory ap-
paratus. Of 149 cases of malocclusion examined, there were 65 mal-
formations in the enamel-covering of the teeth; 19 anomalies in the
size and form of the teeth; 98 irregularities in the shedding of the decid-
uous teeth, and in irregularities in the eruption of the permanent series.
It may therefore be concluded that of the numerous factors that enter
into the etiologic problem of malocclusion of the teeth, internal secretion
is the one which may, in a large measure, account for many mysteries
that perplex the orthodontist. The appreciation of the paramount
importance of this factor will be evident in proportion as more knowl-
edge is gained with reference to the profound working of this most wonder-
ful system of glands.
THE MERCURIAL TREATMENT OF PYORRHEA ALVEOLARIS
By C. S. Copeland, D.D.S., Rochester, N. Y.
The nlany "cures" for pyorrhea alveolaris which have been presented
to the dental profession during the past few years have demonstrated
that we are alive to the importance of combating this dreadful disease
and its secondary systemic infections. Each has had its fair and im-
partial trial and been found wanting, yet each has contributed its small
mite to the process of elimination and to the survival of the fittest.
That local instrumentation and treatment has not been eliminated in
this contest is conceded by all contestants. That mercuric sucdnimid
properly injected and combined with local treatment effects a cure in all
but hopeless cases I have demonstrated to my complete satisfaction.
Digitized by V:iOOQIC
AN EPITOME OF CURRENT DENTAL AND MEDICAL LITERATURE 191
Systemic infections secondary to pyorrhea are also cured by this treat-
ment
While my experience and investigations with this mercurial treatment
have been limited to the above cases, they certainly verify the reports
of Dr. Wright and Dr. White of the Portsmouth Navy Yard. To those
who expect a few injections of mercuric sucdnimid alone to cure pyorrhea,
let me again emphasize the absolute necessity for careful local instru-
mentation and treatment, for it is only by this combination that such
wonderful results have been obtained. For the benefit of those who do
not understand the technique of mercurial injections, it is described here
in full, just as I saw it carried out by Dr. Wright while at the Portsmouth
Navy Yard. This technique is simple and easily mastered, and as all
dentists have the legal right to administer any and all of the drugs in
the pharmacopoeia, either locally or systemically, there is absolutely no
reason why they should not make their own injections. In the case of
female patients, only a small area need be exposed, the rest of the body
being draped with sheeting by an assistant.
TECHNIQUE
The syringe used is made by Burroughs, Wellcome & Co., all glass,
and holding forty minims. The needles used are No. 26, intra-muscular,
for the above syringe.
Syringe and needle are sterilized before using. The solutions are so
made that gr. 1/5 of mercuric sucdnimid is dissolved in four minims of
hot, sterile distilled water. .
The site of injection is the buttock, using alternating sides for suc-
ceeding injections. The skin is sterilized with tincture of iodin. The
method of inserting the needle is as follows: The needle butt is held be-
tween the thumb and third finger with the index finger over the butt, the
shaft of the needle to be perpendicular to the skin surface, the point
about three inches distant from it. With a quick, forceful, downward
thrust, the needle is driven deeply into the substance of the gluteal mus-
cles, from point to butt. Then into the syringe as many minims of the
sterile mercuric solution as represent the desired dose, are drawn; if it
is to be gr. 5/5, minims xx will be required. Then the syringe tip is in-
serted into the socket of the needle, and the injection is made slowly.
The needle is withdrawn, and tincture of iodin is applied to the point
of injection. The injections are to be repeated every seventh day.
In conclusion let me say that I believe the profession and humanity
are greatly indebted to Dr. Barton Lisle Wright, surgeon U. S. Navy, for
this wonderful discovery. It seems that at last we have conquered a
disease that has puzzled and endangered the human race from time im-
Digitized by V:iOOQIC
102 THB DENTAL DIGBST
memorial. Perhaps the most satisfactory part of this discovery is that
the discoverer is an American, an officer in that most efficient organiza-
tion, the United States Navy.
[The Dental OtUlook, February, 1916]
Original Communications
♦The Relationship of the Pediatrist and the Dentist. By G. R. Pisek, M.D.
Impression Method for Edentulous Mouths, with Modeling Compound. By Dr. J. P. Ruyl.
A Suggestion. By H. Schwamm, D.D.S., LL.B.
The Purpose of Our Dental Societies and Their Official Organ, "The Dental Outlook."
By S. Herder, D.D.S.
Quality and Quantity. By Dr. M. Schneer.
Mounting of Crown and Bridgework. By Goslee.
Hails Awakened Health Conscience.
Monthly Report of Legislation Committee of The Allied Dental Council.
Editorial
Proposed New Law Regulating Administration of General Anesthetics by Dentists.
THE RELATION OF PEDIATRIST AND DENTIST
By G. R. Pisek, M.D., New York
It is a sad fact shown by a committee of the A. M. A. that 48.8 per
cent, of the children of rural communities and 33.50 per cent, of city
children were found to have defective teeth, and we are only now just
beginning to scratch the surface very feebly with a few dental clinics to
correct these defects. The physicians need the whole-souled cooperation
of dentists in the care of the mouth of the child. It must be admitted
that the dentists have not given of their best to the child. The rank and
file of the dental profession as a whole, have not supported in practice the
contention that the primary teeth should be carefully preserved. Ex-
traction is too often resorted to where a filling could have been placed if
the necessary time and patience were used.
There is a need for dentists who are willing to devote attention to the
mouths of children, and who would take charge in the same manner as
the physician would in cases of specific illness. There should be more
personal cooperation between the physician and the dentist, particularly
in the cases to be mentioned later in which other therapeutic aids besides
the orthodontic are necessary to affect the well being of the child.
Physicians in the last few years have had their attention forcibly
called to the foci of infection, which may occur in or about the mouth.
They are aware of the fact that a number of diseases heretofore of ob-
scure etiology may be attributed to pus pockets at the roots of teeth.
Digitized by
Google
AN EPITOME OF CURRENT DENTAL AND MEDICAL LITERATURE 193
In fact the pendulum is perhaps swinging too far in this one direction,
but nevertheless attention is well centred upon the hygiene of the mouth
and the dental profession should be prepared and ready to cooperate
with physicians, seeking advice for their patients. The effort must centre
Itself in the prevention of dental caries and Rigg's disease. Early and
serious dietetic errors during infancy and the early years of life have a
marked effect on the production of irregular dentition, deformed and
carious teeth. The dentist should be able to recognize the effects of
improper diet in the mouth, and be capable of recognizing that the con-
dition is due to dietetic error.
The dentist need not and should not attempt to regulate the feedings
of children, but he should have a clear conception of the scientific founda-
tions of the art, so that he may be able to detect the evidences of improper
feeding and direct his patient into the right channels for correction.
The maternal nutrition of the infant commences at conception. The
developing ovum at first absorbs nutriment from the fluids by which it is
surrounded, but as the organism develops it attaches itself to the wall of
the uterus and through it obtains food. As organization becomes more
complex the placenta is formed, and gradually the circulation of the blood
is established. When birth occurs a sudden change in the method of
obtaining food takes place. The mother now supplies it from the breasts
instead of through the placenta. At first she secretes colostrum, but
this is soon displaced by milk which she supplies until teeth are cut and the
infant is ready for solid food. During the time the infant is at the breast
its digestive organs are slowly assimiing the form of those of the adult
and are gradually developing their functions, as is shown by the ability
to take solid food a littie at a time. During the time the digestive organs
are developing Nature sees that the infant has food that is specially
suited to it.
The reason why foods that do not contain fresh milk are not suc-
cessful in the long run for feeding infants, is that they do not have the
property of adapting themselves to the changing stomach and keeping it
prof)erly at work. Unmodified cow's milk disagrees with most young
infants because of the character of the solid formed from it when it comes
in contact with the pepsin of the stomach.
Most important from the dental standpoint is the fact that, the true
growth of the body — the formation of muscle and bone — is absolutely
dependent on the proteid obtained from the food, which is represented
by lean meat, eggs, curd of milk, gluten of cereal, etc. If this element
of the food is deficient, a weakened constitution will result, although the
infant may gain in weight rapidly if there is sufficient sugar present. If
there is enough proteid, but insufficient sugar and fat in the food, stunting
Digitized by
Google
194 THE DENTAL DIGEST
will follow because the proteid cannot'be stored up as new tissue, but must
be used for the current needs of the body, which would normally be met
by the sugar and fat.
Again the dentist should be able to differentiate the syphilitic teeth
of the second dentition from the irregular, deformed teeth occurring in
the mouths of children with mental deficiencies.
From the pediatrician's standpoint the dentist should recollect that
children who are artificially fed, have generally weaker teeth.
[Dominion Dental Journal, January, 1916]
Contents
Original Communications
•Systemic Disorders as the Result of Oral Sepsis. By Andrew J. McDonagh, D.D.S., L.D.S.,
Toronto, Ont.
Abscess of the Antrum. By E. C. McDonald, D.D.S., Toronto, Ont.
A Better Knowledge of Dental Pathology Desirable. By F. H. Krueger, D.D.S., L.D. S.,
Toronto, Ont.
An Antrum Case of Long Standing. By A. E. Webster, M.D., D.D.S.
Amalgam Technique.
A Trip in War Times. By A. W. Thornton, D.D.S., L.D.S., Montreal, Que.
Duty and Responsibility of Members of Faculty Council of the Royal College of Dental
Surgeons of Ontario. By A. E. Webster, D.D.S., L.D.S., M.D., Dean.
The Recently Embarked Overseas Draft of the Canadian Army Dental Corps. By James M.
Magec, D.D.S., L.D.S., St. John, N. B.
Dental Societies
Ontario Oral Hygiene Conference.
Toronto Dental Society.
Medical Inspection Department, Calgary.
"Canada." By Mark G. McElhinney.
Editorial
Dental Students Who Enlist.
Military Convalescent Hospitals in Canada.
The Dentist is More than a Mechanic.
Correspondence
Letter from Jos. Nolin.
Obituary
Clarence R. Minns, D.D.S., L.D.S.
SYSTEMIC DISORDERS AS THE RESULT OF ORAL SEPSIS
By Andrew J. McDonagh, D.D.S., L.D.S., Toronto, Ont.
If a tooth has an abscess encompassing the end of the root, which is
apparently encysted, at the end of the roots of the teeth immediately
Digitized by V:iOOQIC
AN EPITOMB OF CURRENT DENTAL AND MEDICAL LITERATURE 19$
adjoining that tooth, although the teeth are alive and perfectly healthy,
will be found the same micro-organisms as are contained in the abscess,
showing that the micro-organisms have penetrated the walls of the abscess
and invaded the contiguous tissues, showing also a probable avenue into
the circulation. Now, the harm which may be done if these organisms
enter the circulation either by this avenue or any other avenue which we
will speak of later on, may be done either by destroying the blood itself;
in other words, by haemolyzing it, or the harm may be done by the blood
stream carrying these organisms to distant parts of the body, where they
will find congenial habitation, notably in the heart, the joints and cellular
tissue. There is a great difference in opinion between pathologists as to
the proportion of alveolar abscesses which contain haemolytic organisms,
Hartzell claiming that in his investigations only one in two hundred
abscesses contained haemolytic organisms. This great difference of
opinion possibly is accounted for by the different manner in which investi-
gators culture their organisms, but in my experience there is this to say,
if the organism in a blind abscess is a haemolytic organism, the abscess
is much smaller and much more difficult to find by X-ray. This probably
is due to the difference in the pyogenic qualities of the two organisms.
In making and reading radiographs our difficulties are enhanced, be-
cause an abscess caused by an infected pulp canal does not always form
at the end of a root, does not always form in a position easily detected in
a skiagram; in other words, the root very often hides the abscess, and
your only guide is the condition of the lineadura and your knowledge of
the appearance a healthy root ought to have. This is exceptionally true
of the molars on which the abscess often forms at the bifurcation of the
roots, and is an exceedingly virulent abscess. A man to make a diagnosis
should never absolutely rely upon his skiagram; he must use either
thermal changes or high pressure electric current, or both, to help in his
work. Just one word more about abscesses on the teeth. It is not
unusual for a man examining a patient's mouth to base his diagnosis on
that which is most apparent, namely, sinuses and visable concretions.
Nothing in this field is more deceiving or more disappointing. Multiple
abscesses discharging through sinuses into the mouth are not as bad as
one abscess (so-called blind abscess) which has no sinus, the whole con-
tents of which must be absorbed by the surrounding tissue, and we must
not forget that in this case the surrounding tissue is composed of highly
vascular cancellous bone.
These blind abscesses very often, in fact, in the majority of cases, do
not cause any great discomfort to the patient; the teeth are not sore, the
gums are not swollen, and if you make a single X-ray plate of all the
teeth ancl the jaws pf the mouth you may not discover the abscess.
Digitized by
Google
196 THE DENTAL DIGEST
Another fact which is sometimes overlooked is that organisms contained
at the end of the different teeth roots in the mouth may be, and very
often are, as different as possible in different localities in the same mouth;
that is, you may have at the end of one of the centrals a non-haemolytic
streptococcus veridans, and at the end of a bicuspid root a haemolytic
streptococcus, and so on, consequently every root and every abscess sac
must be made sterile.
[Journal American Medical Association^ January 15, 1916]
THE ACTION OF COCAIN
Aside from its action as a local anesthetic, and its stimulating and
then depressing action on various parts of the central nervous system,
cocain has three effects which have especially aroused the interest of
clinicians and pharmacologists. These are the dilation of the pupil, the
local constriction of certain blood vessels, and the acceleration of the
heart sometimes seen in cases of poisoning by this drug. The first two
are of very practical importance. Cocain is in constant use as a mydri-
atic, and extensive use is also made of its constricting action on the dilated
vessels of the conjunctiva, etc. Its advantages as a local anesthetic
over its more recent rivals are in part attributed to its local vasoconstrict-
ing effect. Since the introduction of mixtures of novocain, etc., and
epinephrin, however, this inherent advantage of cocain has become of less
importance; the epinephrin adds to these mixtures an important action
not p)ossessed by the anesthetics alone.
There has been much discussion as to just how cocain brings about
dilatation of the pupil and the local constriction of blood vessels. For
many years the view has been current that it stimulates the. endings of
the sympathetic nerves in the iris. This view was based chiefly on the
observation that after these nerves were cut and allowed to degenerate,
cocain had a much less dilating effect on the pupil, or none at all. This
explanation has never been entirely satisfactory; all writers have had
to admit that it does not explain all the observed facts. It has been
accepted, however, as the more plausible explanation for the major part
of the facts, and recent writers seem to have been little disturbed by the
facts which it does not explain. The other actions, the vasoconstricting
and the acceleration of the heart, have not been the subject of much inves-
tigation, but there has been a tendency to explain them also as a result
of an increased activity of sympathetic nerve endings.* In fact, cocain
is now frequently grouped with epinephrin as a drug having a selective
♦Meyer, H. H., and Gottlieb, R,: Pharmacology, Clinical and Experimental, p. 158.
Digitized by V:iOOQIC
AN EPITOME OF CURRENT DENTAL AND MEDICAL LITERATURE 197
Stimulating action on the endings of the true sympathetic nervous
system.*
It appears, however, from recent work carried out by Kuroda,t in
the pharmacologic laboratory of Professor Cushny of London, that such
a generalization was premature and not sufficiently well supported by
experimental facts. Kuroda showed that the action of cocain differs
widely from that of epinephrin or sympathetic nerve stimulation: thus
it dilates the vessels when perfused through an organ, whereas epinephrin
or sympathetic nerve stimulation causes an intense constriction; it de-
presses the action of the isolated heart, whereas sympathetic nerve stimu-
lation or epinephrin powerfully stimulates this organ; small doses of
cocain augment the activity of the intestine, and large doses depress it,
whereas with epinephrin or sympathetic nerve stimulation there is only
a depression. There is a similar lack of correspondence between the
action of cocain and of epinephrin or sympathetic nerve stimulation in
the case of the stomach, uterus, bladder, and salivary glands. In nearly
all cases, cocain was found first to increase the activity of unstriated
muscle and then to depress it, whatever may be the nature of the sym-
pathetic control; in some instances the phase of increased activity was
not observed. In view of these results and the fact that the explanation
that the dilatation of the pupil results from a stimulation of the endings
of the sympathetic nerve has always been regarded as inadequate, Kuroda
argues that the dilatation of the pupil under cocain also arises from a
direct depressing action of the drug on the muscle of the iris. The
vasoconstricting action of cocain which is seen when the drug is applied
directly to a congested mucous membrane is not so readily explained, but
it is evidently of a different character from that caused by epinephrin or
sympathetic nerve stimulation; the effects of the latter agencies are
very evident in isolated organs, and are always readily obtained, whereas
cocain causes a dilation of blood vessels under similar conditions. The
acceleration of the heart in the intact animal is evidently not analogous
to the action of epinephrin; it may be due to an action on the central
nervous system.
At first thought it may seem rather discouraging that there should
still be so much doubt as to the true action of such a widely used mydriatic
as cocain; but it should be remembered that such problems are very
complex and that the number of men seriously working to elucidate
them are few.
•See, for example, Wolfsohn, J. M. : The Normal and Pathologic Physiology of the Visceral
Nervous System, The Journal A. M. A., May i6, 1914, p. 1535.
fKuioda: Jour. Phannacol. and Exper. Therap., 191^, vii, 423.
Digitized by V:iOOQIC
198 THB DBNTAL DIGEST
[Journal American Medical Association^ January 22, 1916]
THE TECHNIC OF ORAL HYGIENE
''Dentistry, which is a highly specialized branch of surgery, should
use the two factors, asepsis and anesthesia, which have made possible
the wonders of modem surgery, with skill and precision equal to that of
surgeons." This is the theme emphasized by Hasseltine* of the United
States Public Health Service as the result of an investigation, imdertaken
at the request of prominent dentists, to work out a detailed method for
sterilizing dental instruments and appliances, keeping in mind the im-
portant factors simplicity, efficiency, and duration of the process of
sterilization. Any one trained in modem methods of asepsis who has
watched the technic at present employed in the usual routine of dental
treatment will have observed the errors which are almost inevitably
allowed to creep in, and the attendant possibility of bacterial contamina-
tion and transmission of infection from one patient to another. The
entire question of oral sepsis and mouth hygiene has been put into even
greater prominence of late by the attention centred on the unexplored
possibilities of infection through the mouth. The situation has been
analyzed by the statement that "from the standpoint of efficiency the
modern mouth is out of adjustment with modem conditions — or, perhaps
we should say, modem conditions are out of adjustment with it. Not-
withstanding the numerous bacteria that flourish within its portals,
mouth secretions and the mucous membranes do not seem to have the
protecting power which is often manifest in other regions of the body
and which protects an animal in a state of nature, "t
The danger from focal infections in which streptococci are present in
the tonsils and about the teeth is becoming more widely appreciated now
that the possibilities for harm in such chronic foci are being recognized
on the basis of careful scientific investigation. In referring to what may
be called "internal streptococcal metastasis" attended by the localization
of mouth streptococci in the interior of the body, it was pointed out
recetitlyj that the efforts now made to detect and then to obliterate all
forms of focal infection in the mouth and throat as well as elsewhere in
the body, for preventive as well as curative purposes, besides being in
accord with sound reasoning from general principles, receive the support
also of strong experimental evidence.
As illustrations of the possibility of transmission of mouth organisms
♦Hasseltine, H.E.: The Sterilization of Dentallnstruments, Bull. loi, Hyg. Lab., U. S.
P. H. S., 1915, p. 53.
tHow to Live, New York, Funk and Wagnalls, 1915, p. 78.
JThe Localization of Strept99p9fij editori^, Jhe /oj4fftfU A. M. A., Nqy, X^, i§i$, p. 173a,
Digitized by
Google
AN EPITOME OF CURRENT DENTAL AND MEDICAL LITERATURE 199
from one person to another through the medium of dental practices,
Hasseltine* mentions the placing of sterilized instruments on a swinging
tray or glass plate which has not been sterilized, the cleaning of burs on
a scratch wheel which has not been sterilized since the burs used on the
previous patient have been cleaned on it, and the frequent handling of
the cable of the dental engine, which receives contamination from one
patient through the operator's hands and in turn returns a portion of this
contamination to the operator's hands when used on subsequent patients.
These familiar errors, as Hasseltine expresses it, emphasize the necessity
of having everything which comes in contact with the instruments or
hands of the operator free from organisms obtained from previous patients
in order to prevent transmission of infection from one patient to another.
Every dentist or oral surgeon will find useful hints and practical sug-
gestions in the outcome of the investigation of the Hygienic Laboratory.!
The reconunendations for the sterilization of dental instruments point
out that moist heat is our best disinfecting agent for the sterilization of
all metal instruments. For the destruction of nonspore-bearing bacteria,
moist heat at 80 C. (176 F.) is nearly as efficient as boiling, and for
practical purposes can be used in place of boiling. Instruments con-
structed of metal, whose complicated mechanism has heretofore caused
them to be considered as nonsterilizable, can be sterilized by moist heat,
provided the water is removed from them by immersing in alcohol sub-
sequent to sterilization. Instruments whose construction does not
permit of boiling can be sterilized by chemical disinfectants. In the
latter procedure, immersion in 5 per cent, solution of phenol (carbolic
add) for at least sixty minutes is recommended; and in those cases in
which the mechanical construction makes it difficult to remove excess of
water, instruments can be placed in 95 per cent, alcohol for a few minutes
to remove water, and then allowed to dry.
The courses of instruction in dental surgery of to-day are giving atten-
tion to the bacteriology of the subject and its relation to mouth hygiene
as well as to general health. It is, however, a distinct advantage to have
the practical results of actual tests of sterilizing agents ' available for
professional men who have Uttle opportunity for personal experience
in the laboratory work involved. Hasseltine well remarks that the
student usually forms the opinion that any sterilizing agent is effective,
and does not learn to check his sterilization by bacteriologic tests. For
this reason he believes that in dental schools and clinics there is need for
the giving of more practical instruction in the methods of sterilization,
and the subsequent testing of these by bacteriologic methods.
*0p. cU. fApplications for the publication referred to should be addressed to the Sur-
geon General, U. S. Public Health Service, Washington, D.C.
Digitized by V:iOOQIC —
200 THB DBNTAL DIGEST
[Journal American Medical Associaiiony February 5, 1916]
(British Medical Journal, January i, 1916)
TREATMENT OF INFECTED GUNSHOT WOUNDS
Army surgeons, according to Gray, have been compelled, since this
war began, to acknowledge the ineflSdency of antiseptics when used as a
preventive or for disinfecting agents in badly infected, lacerated woimds.
Until applications were employed which stimulated a concentration of
the general defensive forces of the body in and around the wound, no
real advance in treatment was made. It mattered not what kind or what
strength of antiseptic, pure and simple, was used, the infection ran a
fairly definite course of fairly definite duration, which varied merely
according to the patient's power of resistance. While the importance
of free drainage was speedily acknowledged, quite a long time passed
before there was any satisfactory recognition of the fact that the resisting
agencies of the patient's own body are far more effective in dealing with
a local infection than any purely antiseptic solution, powder, or paste
introduced into it from without. It has been proved that the use of salt
solutions applied in various ways, fulfils all the striking claims made for
it by Wright. Hypertonic saline dressing, especially in the form now
known as the ''tablet and gauze pack," fulfils all desiderata better than
any other yet applied.
After the wound has been cleaned by operation, all the recesses of the
woimd should be sought out by the finger, and filled, fairly firmly,
with gauze wrung out of 5 to 10 per cent, salt solution, in the folds
of which are placed numerous tablets of salt. Blood clot which may form
during the packing should be wiped away. The gauze should be packed
in concertina-wise, a tablet being placed between every third or fourth
fold. A fairly large, fenestrated rubber tube is placed so as to reach
to the deepest part of the main cavity, which is then filled with gauze
and tablets. The dressing is made flush with the skin and the tube pro-
jects slightly from its midst. The surrounding skin is painted with
solution of iodin or other antiseptic application. Two or three layers of
gauze are then used to cover the woimd and surroimding skin. A suitable
amount of absorbent cottonwool is applied and a bandage wound on
smoothly and firmly.
[The Internalional Journal of Orthodontia, January, 1916]
Contents
Original Articles
Suggestions in X-ray Technic for the Orthodontist. By Dr. James David McCoy, Los
Angeles, Calif.
Digitized by V:iOOQIC
AN EPITOME OF CURRENT DENTAL AND MEDICAL LITERATURE 201
An Effective Method for the Mesial or Distal Movement of Individual Teeth in the Arch.
By Harry E. Kelsey, D.D.S., Baltimore, Md.
Treatment by the Orthodontist Supplementing that by the Rhinologist. By A. H. Ketcham,
D.D.S., Denver, Colo.
The Technic of Accurate Impression Taking. By Samuel J. Lewis, D.D.S., Kalamazoo,
Mich.
The History of Orthodontia (Continued). By Bemhard W. Weinberger, D.D.S., New York
City.
Editorials
Cooperation between the Dentist and the Orthodontist.
Bands vs. Ligature.
The Teaching of Orthodontia in Dental Colleges.
The Esthetic Side of Orthodontia.
[Pacific Dental Gazette, January, 191 6]
Original Articles
Efficiency in Tooth Brushing. By Engstrom.
Dental Pediatrics. By Gurley.
The First Plaster Impression, and First Suction Plate. By Haskell.
pAlitorial
Are Root Canals Being Overtreated?
Selections
Chemical Studies of Relations of Micro-Organisms to Dental Caries. Gies and Collaborators.
A Pressing Need in Dentistry. By Johnson.
Practical Suggestions
Conducted by John C. Hopkins, D.D.S.
Dental Excerpts
Concerning Inlays. By Hinman.
The Financial Ally of the Pyorrhea Specialist. By Endelman.
Mercury Chlorid in Surgery.
[The Denial Summary, February, 19 16]
Regular Contributions
Suggestion and Auto-suggestion in its Relation to Dentistry. By W. F. Stone.
Split Matrix and Amalgam Filling. By Drs. Barclay and McCready.
How to Sterilize the Tooth Brush. By Hugh W. MacMillan.
Dental Pathology and its Relation to Systemic Disease. By T. A. Leonard.
Correlating Conditions Common to Nose, Throat, and Oral Surgery. By E. B. Cayce.
Porcelain Inlays. By F. B. Roberts.
Impression Taking, Using Modeling Compound. By J. V. Howard.
What All Dentists Should Know About Orthodontia. By W. E. Lundy.
Digitized by V:iOOQIC
202 THE DENTAL DIGEST
Dates of Some Old Dental Patents. By H. L. Ambler.
President's Address. By David P. Houston.
Some Thoughts on Education. By Henr>' W. Morgan.
Pyorrhea. By A. ClifTord Braly.
Some Dental Hints. By J. B. Kelly.
The Sterilization of Dental Instruments. By H. E. Hasseltine.
A Review of Some Drugs Old and New. By S. F. M. Hirsch.
Dentistry, in its Progress Through the Century, to Stomatology as a Science. By James
Truman.
Plastic Surgery of the Face. By W. A. Bryan.
Local Anesthesia in Dentistry. By B. H. Johnson.
[Dental Items of Interest^ February, 1916]
Exclusive Conlributions
Origin and Metastatic Importance of Chronic Oral Infections. By E. J. Eisen, D.D.S.;
R. H. Ivy, M.D., D.D.S.
A Short Cut in the Indirect Method of Making Cast (>old Inlays. By Louis Herbst, D.D.S.
Radiodontia
"Bad Canal Work"; What ShaU We Do About it? By Howard R. Raper, D.D.S.
Society Papers
An Acidimetric Study of the Saliva and Its Relation to Diet and Caries. By John Albert
Marshall.
Medical Superstitions. By Garrett Newkirk.
The Professional Side of Dentistry. By Frank P. Duflfy, D.D.S.
[The Texas Dental Journal^ January, 1916]
Original Communications
The Evolution of Prosthetic Dentistry.
The Bigness of Little Things.
The Dentist: Who Is He?
With Our Contemporaries
Modern Attachments for Bridge Work.
Malarial Mosquitoes as the Food of Bats.
Should All Teeth Be Saved?
Operative Procedures in Relation to Dental Caries and Diseases of the Investing Tissues.
Relationship Between Medicine and I)entistr\'.
Porcelain-Faced Molar Cro\N-n.
Gold Inlays with Synthetic Cement Inserts.
Hemorrhage, Post-Operative — The Use of Coagulose as a Prophylactic.
Digitized by V:iOOQIC
SOCIETY NOTES 203
SOCIETY NOTES
Alabama.
The next meeting of the Alabama Dental Association will be held at Mobile, Ala., April
II, 1916. — J. A. Blue, Birmingham, Ala., Secretary,
Arkansas.
The next meeting of the Arkansas State Dental Association will be held at Little Rock,
Ark., March 28-30, 1916. — Wm. B. Dorman, Nashville, Secretary,
Florida.
The next meeting of the Florida State Dental Society will take place at Orlando, Fla.,
June 21, 1916. — M. C. Izlar, Ocala, Fla., Secretary.
Ilunois.
The Illinois State Dental Society will hold its next meeting at Springfield, 111., May
9-12, 1916. — Henry L. Whipple, Quincy, TIL, Secretary.
Iowa.
The next meeting of the Iowa State Dental Society will take place at Des Moines, Iowa,
May 2-4. — H. A. Elmquist, Des Moines, Iowa, Chairman of Exhibit.
Maryland.
The next meeting of the Maryland State Dental Association will be held in Baltimore,
Md., March 25, 1916. — F. F. Drew, Baltimore, Md., Secretary.
Massachusetts.
The next meeting of the Massachusetts Dental Society will be held in Boston, Mass.
May 3-5, 1916. — A. H. St. C. Chase, Boston, Mass., Secretary.
Michigan.
The Michigan State Board of Dental Examiners will meet in the Dental College at Ann
Arbor, June 19, 1916, at eight o'clock a.m.; for application blanks apply to E. O. Gillespie,
Stephenson, Mich., Secretary-Treasurer.
Mississippi.
The next meeting of the Mississippi Dental Association will be held at Jackson* Miss.,
May 1-3, 1916. M. B. Varnado, Osyka, Miss., Secretary.
Missouri, Kansas, Oklahoma.
The Tri-State Post Graduate Dental meeting will be held at Kansas City, Mo., March
20-26, 1916. — C. L. Lawrence, Enid, Okla., Secretary.
Nebraska.
The Nebraska State Dental Society will hold its next meeting in Lincoln, Nebr., May
16-18, 1916. — H. E. King, Omaha, Nebr., Secretary.
New York.
The Dental Society of the State of New York wall hold its next meeting at the Hotel
Ten Eyck, Albany, N. Y., May 11-13, 1916. — A. P. Burkhart, 52 Genesee St., Albany,
N. Y., Secretary.
New York.
The next meeting of the Sixth District Dental Society of New York will be held at Hotel
Bennett, Binghamton, N. Y., March 23-25, 1916. — William A. Ogden, Chairman
Arrangement Committee.
Pennsylvania.
The fifty-third annual meeting of the Lake Erie Dental Association will be held at Hotel
Bartlett, Cambridge Springs, Pa., May 18-20, 1916.— J. F. Smith, 120 W. i8th St., Erie,
Pa., Secretary.
Digitized by V:iOOQIC
204 THS DENTAL DIGEST
South Carolina.
The forty-sixth annual meeting of the South Carolina State Dental Association will be
held at Chick's Springs, So. Car., July 11-13, 1916.— Ernest C. Dye, Greenville, So.
Car., Secretary.
Texas.
The Texas State Dental Association will hold its next meeting at Dallas, Texas, May
9-12, 1916.— W. O. Talbot, Fort Worth, Texas, Secretary.
West Virginia.
The next meeting of the West Virginia State Dental Association will be held at the
Kanawha Hotel, Charleston, W. Va., April 12-14, 1916.— J. W. Parsons, Huntington,
W. Va., Secretary.
Wisconsin.
The meeting of the Wisconsin State Board of Dental Examiners will be held at the Mar-
quette Dental College, Cor. 9th and Wells St., Milwaukee, Wis., June 14, 1916, commenc-
ing at nine o'clock. — F. A. Tate, Daniels Blk., Rice Lake, Wis., Secretary,
AMERICAN INSTITUTE OF DENTAL TEACHERS
At the last annual meeting of the American Institute of Dental Teachers held at Minne-
apolis, Minn., January 25-27, 1916, the following officers were elected: President, Dr.
Shirley W. Bowles, 1616 I Street, Washington, D. C; Vice-President, Dr. John F. Biddle,
517 Arch Street, Pittsburgh, Pa.; Secretary-Treasurer, Dr. Abram Hoffman, 529 Franklin
Street, Buffalo, N. Y.; Executive Board, Dr. A. W. Thornton, Montreal, Canada, Dr. R. W.
Bunting, Ann Arbor, Michigan, and Dr. A. D. Black, Chicago, 111.
The next annual meeting will be held at Philadelphia, January 23, 24, 25, 191 7.
ODONTOLOGICAL SOCIETY OF WESTERN PENNSYLVANIA
The thirty-fifth annual meeting of the Odontological Society of Western Pennsylvania
will be held at the Monongahela House, Pittsburgh, Pa., Tuesday and Wednesday, April
II and 12, 1916.
The first regular session of the society will open on Tuesday at 10 a.m. The Executive
Council will meet at the Hotel at 9.30 a.m. for the transaction of business in the interest of
the society. The clinics and exhibits will be at the Monongahela House. Exhibitors are
cordially invited to visit this meeting, and requested to make early reservation for space.
A cordial invitation is extended to all ethical dentists in Pennsylvania and adjoining
states.
King S. Perry, Secretary.
719 Jenkins Bldg., Pittsburgh, Pa.
PATENTS
1112561, Tooth brush, Edwin H. Rodell, Cummings, N. D.
1 112847, Centered mold for dental castings, Heinrich Schweitzer, New York, N. Y.
46510, Design, Sanitary tooth cleaner, Edwin G. Over, Fort Worth, Texas.
1113752, Dental handpiece, Alexander Campbell, Los Angeles, Cal.
1 1 13325, Implement for forming metal backs for artificial teeth, Ernest D. R. Garden, Los
Angeles, Cal.
1 1 14624, Tooth straightening appliance, A. G. Meier, St. Louis, Mo.
1 1 14646, Tooth brush, Lajos Pap, Arad, Austria-Hungary.
1114291, Orthodontic appliance, Ray D. Robinson, Los Angeles, Cal.
1115061, Tooth brush holder, John B. Foster, Newark, N. J.
Digitized by
Google
FUTURE EVBNTS 205
m5779} Dental flask and means for dosing and fastening the parts thereof, George Bninton,
Leeds, England.
1 1 16056, Apparatus for fumigating dental cavities, Henri Grasset, Paris, France.
1 1 15678, Dental casting apparatus, W. B. C. Kaiser, Hamburg, Germany.
1116310, Sanitary dental tray, N. A. Maser, Vineland, N. J.
1115718, Dental instrument, Wm. H. Mosley, Toronto, Ont., Canada.
1 1 16868, Saliva ejector, A. A. Anzelewitz, New York, N. Y.
1116371, Artificial denture, Ernest C. Bennett, New York, N. Y.
1 1 16497, Tooth bridge, Friedrich Schreiber, Berlin, Germany.
1 1 17660, Dental apparatus, John M. Gilmore, Chicago, HI.
II 17701, Dental syringe, F. L. Piatt, G. N. Hein, and R. R. Impey, San Francisco, Cal.
111727s, Dental impression tray, S. G. Supplee, East Orange, N. J.
11 17276, Taking partial impressions for artificial dentures, S. G. Supplee, East Orange, N. J.
1 1 17277, Heating apparatus, S. G. Supplee, East Orange, N. J.
II 17928, Attachment for dental impression cups, W. J. Thurmond, Columbus, Ga.
46650, Design, Tooth brush. Jay Laven^on, Philadelphia, Pa.
1118183, Blowpipe apparatus, W. C. Buckham, Jersey City, N. J.
1118301, Filling teeth, Thomas B. Magill, Kansas City, Mo.
1118156, Making a tooth brush, Joseph Schoepe, New York, N. Y.
T 1 18703, Dental bridgework, George W. Todd, Omaha, Nebr.
Copies of above patents may be obtained for fifteen cents each, by addressing John A.
Saul, Solicitor of Patents, Fendall Building, Washington, D. C.
FUTURE EVENTS
March 14, 1916. — Fox River Valley Dental Society, Appleton, Wis. — R. J. Chady, Oshkosh,
Wis., Secretary.
March 20-26, 1916. — ^The Tri-State Post Graduate Dental Meeting (Missouri, Kansas,
Oklahoma), Kansas City, Mo. — C. L. Lawkence, Enid, Okla., Secretary.
March 23-25, 1916. — Sixth District Dental Society, Binghamton, N. Y., Hotel Bennett. —
William A. Ogden, Chairman Arrangement Committee,
March 25, 1916. — Maryland State Dental Association, Baltimore, Md. — F. F. Drew, Balti-
more, Md., Secretary.
April 4-7, 1916. — Dental Manufacturers' Club, Chicago, 111. Meeting in the Banquet Hall,
Auditorium Hotel. — Chairman Exhibit Committee, A. C. Clark, Grand Crossing, Chicago.
April II, 1916. — Alabama Dental Association, Mobile, Ala.
April 12-14, 1916. — West Virginia State Dental Association, Kanawha Hotel, Charleston.
April 13-15, 1916. — Michigan State Dental Society, Detroit, Michigan. — Clare G. Bates,
Secretary.
May, 1916. — Susquehanna Dental Association, Scranton, Pa. — Geo. C. ELnox, 30 Dime
Bank Bldg., Scranton, Pa., Recording Secretary.
May, 1916. — Indiana State Dental Association, Claypool Hotel, Indianapolis, Ind. — A. R,
Ross, Secretary.
May 2-4, 1916. — Iowa State Dental Society, Des Moines, la. — H. A. Elmquist, Des Moines,
la.. Chairman of Exhibit.
May 3-5, 1916. — Massachusetts Dental Society, Boston, Mass. — A. H. St. C. Chase, Boston,
Mass., Secretary.
May 9-10, 1916. — North Dakota State Dental Association. — A. Hallenberg, Fargo, No.
Dak., Chairman Exhibit Committee.
May 9-12, 1916. — Texas State Dental Association, Dallas, Tex. — ^W. O. Talbot, Fort Worth,
Tex., Secretary.
May 9-12, 1916. — Illinois State Dental Society, Springfield, 111. — Henry L. Whipple,
Quincy, HI., Secretary.
Digitized by V:iOOQIC
206 THE DENTAL DIGEST
May 11-13, 1916. — Dental Society of the State of New York, Hotel Ten Eyck, Albany , N, Y.
— A. P. BuRKHART, 52 Genesee St., Albany, N. Y., Secretary.
May 16-18, 1916. — Nebraska State Dental Society, Lincoln, Neb. — H. E. King, Omaha,
Neb., Secretary.
May 18-20, 1916. — ^Lake Erie Dental Association, Hotel Bartlett, Cambridge Springs, Erie,
Pa. — J. F. Smith, Secretary.
June 1-3, 1916. — Northern Ohio Dental Association, Cleveland, O. — Clarence D. Peck,
Sandusky, O., Secretary.
June 8r-io, 1916. — Georgia State Dental Society, Macon, Ga. — M. M. Forbes, Candler
Bldg., Atlanta, Ga., Secretary.
June 13-15, 1916. — Connecticut State Dental Association, Hotel Griswold, New London,
Conn. — Elwyn R. Bryant, New Haven, Conn., Secretary.
June 21,1916. — Florida State Dental Society, Orlando, Fla. — M. C. Izlar, Corresponding
Secretary.
June 20-22, 191 6. — New Hampshire Dental Society, Lake Sunapee, Zoo-Nipi Park Lodge,
Lisbon, N. H. — J. E. Collins, Chairman Exhibit Committee.
June 27-29, 1916. — Pennsylvania State Dental Society, Pittsburgh, Pa. — Luther M.
Wea\'er, 7103 Woodland Ave., Philadelphia, Pa., Secretary.
June 28-30, 1916. — North Carolina State Dental Society, Asheville, N. C. — R. M. Squires,
Wake Forest, N. C, Secretary.
July 11-13, 1916. — South Carolina State Dental Association, Chick's Springs, S. C. — Ernest
C. Dye, Greenville, S. C, Secretary.
July 11-13, 1916. — Wisconsin State Dental Society Meeting, Wausau. — Theodore L.
Gilberton, Secretary.
July 12-15, 1916. — New Jersey State Dental Society, Asbury Park, N. J. — John C. Forsyth,
Trenton, N. J., Secretary.
July 25-28, 19 1 6. — National Dental Association, ist Regiment Armory, LouisWUe, Ky.- ^
Otto U. King, Huntington, Ind., Secretary.
October 18-20, 191 6. — Virginia State Dental Association, Richmond, Va. — C. B. Gifford,
Norfolk, Va., Corresponding Secretary.
January 23-25, 191 7. — American Institute of Dental Teachers, Minneapolis, Minn. — Abrau
Hoffman, 529 Franklin St., Buffalo, Secretary-Treasurer.
TOO BUSY TO READ?
''An hour with a book would have brought to his mind
The secret that took him a whole year to find.
The facts that he learned at enormous expense
Were all on a library shelf to commence.
Alas! for our hero; too busy to read,
He was also too busy, it proved, to succeed.
"We may win without credit or backing or style,
We may win without energy, skill or a smile.
Without patience or aptitude, purpose or wit —
We may even succeed if we're lacking in grit;
But take it from me as a mighty safe hint —
A civilized man cannot win without print.''
— Unknown, Copied from Iowa State Bulletin.
Digitized by
Google
CONTENTS FOR APRIL, 1916
CONTRIBUTED ARTICLES
PAOB
Shall we Discontinue Devitalization ? Walter S. Kyes, D.D.S. 207
Sugar and its Effect upon the Teeth John S. Engs, D.D.S. 212
A Technique of Natural Tooth Bleaching in the Mouth
Louis Englander, D.D.S. 215
Adjusting Obturators. . . J. E. Kurlander, D.D.S., and H. J. Jaulusz, D.D.S. 217
Things that are Said in Dental Journals Hillel Feldman, D.D.S. 219
Hartford Men Contribute to Forsyth Loving Cup 220
New Method of Constructing Full Dentures Clyde Davis, D.D.S. 221
Indictment Against Dentist Quashed 223
First University Dental School in New York, for Columbia 225
BUSINESS BXnLDING
What Shall We Charge for Plates? ■;226; Proof of Malpractice in Dentistry, 234;
Answer to a Request for Advice, 235; How to Make a Dentist Happy, 238;
The Business Side of Dentistry, 2395 The Dentist's Office Hours, 241; This
Patient Frankly Leaves the Reward to God, 241; The Efficiency of the "Trubyte
Teeth," 243; Dr. Williams Needs Teeth, 225.
PRACTICAL HINTS 244-246
DIGESTS
Proposed Statements of Aims and Objects, 247; Advice to Those About to Wear
Artificial Teeth, 249.
AN EPITOME OF CURRENT DENTAL AND MEDICAL LITERATURE ..251-270
SOCIETY NOTES 271
FUTURE EVENTS 2 73
INDEX TO ADVERTISING SECTION 50
Digitized by V:iOOQIC
To satisfy some old friends, here
is a diflferent announcement from
our usual page featuring Ribbon
Dental Cream.
If you prefer Powder — prescribe
C0L06TE*S
ANTISEPTIC DENTOL POWDER
This standard powder has been used by
numbers of the profession for many years,
during which time it has proved itself
well worthy of the confidence placed
in it by those who prefer a dentifrice in
powder form.
Its safe chalk "base" free from harsh,
sharp matter and its wholesome deter-
gent action, are in keeping with the
reputation of its makers — a firm estab-
lished over a century ago.
A request on your card or
letterhead will bring you a
package of Ribbon Dental
Cream or Colgate's Dental
Powder with our compli-
ments.
COLGATE & CO.
ZBtahUahed 1806
Dept. 21
199 Fulton Street, New York, N.Y.
Digitized by V^OOQK:!
The Dental Digest
GEORGE WOOD GLAPP, D.D.Sm Editor
Published monthly by The Dentkts' Supply Company, Candler Bldg.,
Times Square, 220 West 42d Street, >{ew York, U. S. A., to whom all com-
munications relative to subscriptions, ^dvdrtiSiifg; e^c, Vtip^jld be addressed.
Subscription price, including postage, %l.td pet ^eit t6 all parts of the
United States, Phili})ptnes, Guam, Cuba, »Port(^ ^^q,. Mexica ajid.I}ftw^iiAP.
Islands. To Canada, $^,40. To iV olfit^r cou«it^i^:$x.7S; :• :\ '•• ; • v
Articles intended for publication arid corresporide^nce regarding 'tlie Sailie '
should be addressed EDiTOil t)^i5ft:AL'Di6E^T,.Candi^t"^©ldg:,;Tii|ife5 Square,
220 West 42d Street, New Yixk'^Ni'Y. • :'■*'" ?,,• vJ^'--- f : '•.•* -.•' :..
The editor and publishers are not responsible for the views of authors ex-
pressed in these pages.
Entered as Second Class Matter, at the Post-Office at New York City.
Under the Act of Congress, March 3, 1879.
Vol. XX H
APRIL, 1916
No. 4
TICLE5
SHALL WE DISCONTINUE
DEVITALIZATION?
By Walter S. Kyes, D.D.S., Parser, S. D.
A number of yea.rs ago there came into my office a young man for
whom I treated and crowned a lateral incisor. Some time later he again
appeared at the door of my office with several places on his heretofore
smiling and pleasant visage, badly bruised and discolored until his face
seemed almost as expressionless and quite as black as a stove lid. The
crown of gold was missing. I noticed this before I made the hasty study
of the varying shades of his countenance, which observation was probably
due to the presence in my mind of what might be termed conunerdalism.
When I speak of commercialism I mean that force which, if not properly
controlled, will get so hopelessly scrambled with our ethics.
The young man's selfpossession was deeply disturbed. In confusion
he inserted his index finger in his vest pocket and took therefrom the
missing tooth. I did not ask how it happened; the storm clouds on his
face conveyed to me the information more plainly than could words.
I seated him in the operating chair and in the course of a few minutes
he gave me the details which led up to the loss of the lateral incisor.
It seemed that since his previous visit, he had, through frugality and
inheritance, become the owner of a tract of land. The correct location of
Digitized by
Google
208 THE DENTAL DIGEST
one of the surrounding fences was in dispute, and in the effort to straighten
the matter out with his neighbor he had overlooked the majesty of the
law and its innumerable avenues for the absorption of wealth in the
settlement of such cases, and had made use of more convenient and prime-
val methods at**BaliH jt^dtoeilted in his present disfigurement.
fitted
a gold
crown oji aji ^tep^F. tootji. . Qt^ijigi^^ J; examined the apex of the
tootJijaiuJ IjyasiiieUghted to liStejthjaJatil^^ end of the root, beauti-
fully rounding out the apex was the tip of a pink guttai>ercha point, placed
with painstaking care exactly where the college professors taught us they
should be placed.
This was the first root canal filling operation of my own that I had
ever had the privilege of examining under such favorable conditions and
it was highly gratifying to me, if not to my patient.
Just how many root canals I have filled so well, I shall never know.
Perhaps the lack of this information will add years to my life and mayhap,
happiness to the years. However, as time has passed and my opportu-
nities for observation have increased, I have been deeply impressed with
the fact that the roots of our treated teeth, like our interproximal spaces,
cover a multitude of short comings.
After making this confession, which I trust will prove adequate for
the most critical minds, I want to discuss briefly the substance of a paper
read by Henry L. Ulrich, M. D., before the Minnesota Academy of Medi-
cine, and later published in the Journal-Lancet, November, 1915.
I have no hope or desire to add to or detract from the value of the
paper; neither shall I endeavor to corroborate nor contradict any of the
statements made there-in, my object in discussing it being none other
than to get the matter before the readers of the Digest and making such
comments as my experience and observation as a practising dentist have
taught me.
The paper is entitled "Streptococcicosis." The author, taking all re-
sponsibility for the terminology and giving a nimiber of reasons forsodoing.
The two main factors which the writer states he wishes to bring out
in the study are, '^The diversity of clinical manifestations of 'strepto-
coccal focal diseases,' and 'The significance of the blind apical abscess
in' streptococcal focal diseases."
Speaking of the doctrine of focal infections the writer states that, "It
is the tremendous extent of distribution, its adaptability to a variety of
foci, its protean clinical manifestations, which have given the strepto-
coccus this important distinction. "Another very important fact co-
existing with this doctrine is the splendid demonstration of the laws of
Digitized by
Google
SHALL WE DISCONTHOTE DBVITALIZATION? 209
mutation, virulence, and selective actions which these mutants exercise
in establishing fod.
It would seem that these foci of infection are established without
regard for race, color or location, being foimd in all the organs more or
less, including the tonsils, ulcers of the stomach and the appendix and
**last but not least in importance, the blind abscesses at the roots of de-
vitalized teeth."
"The root abscess," continues the writer, "is far more important, far
more significant, than has heretofore been realized. If it were possible
to tabulate all the fod outside the respiratory tract, or lUther outside the
tonsils, the root abscesses of devitalized teeth would lead the list by a
large majority."
"Fifty cases in which blind apical abscesses were present, the cultures
of which abscesses gave types of streptococd, were analysed as to age,
sex and clinical findings."
The author groups these fifty cases into five groups and two sub-groups
three of which I will use for illustration.
1. Rheumatoid group (24 cases).
2. Cardiovascular group (5 cases).
3. Asthenic group (11 cases).
Speaking of the cUnical pathogenidty in group i the author states,
"There were several instances in which no results were obtained by the
removal of the tonsils alone. Not until the dental lesions were destroyed
was there prompt restitution. Other cases reported the removal of the
tonsils and all other foci except the mouth fod. The reduction of these
again gave quick response. The use of vaccines prepared from bacteria
prepared from apical lesions, gave focal reactions, which is abundant
proof of spedfidty. In some instances the removal of some of the fod
of the mouth gave partial relief. On removal of all fod in the mouth,
including teeth of a suspicious appearance, complete and permanent
results were obtained."
In discussing group 2 the author states that, "The proliferation
action of streptococd on vascular endotheUum may well give rise to a
form of endarteritis resulting in general sclerosis with or without subse-
quent hypertension." •
I quote ako the following in regard to gitjup 2 "The value of the
skiagraph of the mouth in establishing an additional or remaining depot
of focal infection in streptococcal disease is unquestioned. The apical
abscess may be the only focus left, the evacuation of which will permit
of the re-establishment of renewed integrity of all parts.
"It may hold the balance of power in the struggle of the body for com-
plete sterilization."
Digitized by
Google
210 THE DENTAL DIGEST
The writer then quotes some figures founded on his investigations
which are both interesting and appalling to the dental profession.
After examining the rontgenographic films of 387 cases in which 997
teeth came under suspicion, he deducts the following. **By conservative
interpretation, 737 root abscesses were seen. There were present 806
artificially devitalized teeth, of these 545 had blind abscesses at the tip
of the roots, and 191 abscesses were present on teeth devitalized either
by accident or pulp destruction by caries." About the only consolatory
feature of these figures is, that the dental profession was not apparently
responsible for the 191 abscesses that resulted from caries and accident.
It occurs to me that it would require further study and a closer analy-
sis of the cases examined to prove that our best efforts in the matter of
root canal filling are wrought with such calamitous failure and with such
possible deleterious effects on the health of our clientele.
It is a well known fact that certain practitioners follow out with vary-
ing degrees of effort and sincerity, certain methods of pulp devitalization
and root canal treatment.
For instance, we have those who adhere to the chloro-percha and gutta
percha point method of root canal filling under the protection of the
rubber dam and various antiseptic agents; again we have those operators
whose proud boast is that they have not had a roll of rubber dam in their
office for a number of years and have treated teeth continuously.
There are also a vast number of operators who use the various mummi-
fying agents, with and without the use of the rubber dam.
The pressure anesthesia method of pulp removal has a host of adher-
ents who are more or less skilled in the removal of pulp debris without the
rubber dam.
Others are as equally enthusiastic about the use of medicated pastes
and mixtures of medicinal agents for root canal fillings.
The writer knows of several offices where hundreds of teeth are treated
every month and no attempt whatever is made to remove the pulp or to
fill the root canals.
The question that presents itself is, what method of treatment and
root canal filling was made use of in the 737 root abscesses observed by
Dr. Ulrich?
It is highly probable that this information could not be obtained from
cases selected at random, but the information would be available if the
cases of a single operator using a particular method were observed, and in
this manner the best method could be arrived at, providing such a one
exists.
Further elucidating the author continues, "The prevention of such ab-
scesses entails a new dental attitude. It is my impression that in the
Digitized by
Google
POSTPONBD ARTICLES 211
days when dentists removed pnlpless teeth, the statistics of chronic rheu-
matoid conditions were much lower than to-day."
The only way in which this impression could be verified would be to
produce the rheumatoid and dental statistics together with those covering
the increase in population for a certain period which is in all probability
more difficult than to fill correctly, a root canal.
"Chronic rheumatoid conditions are decidedly on the increase and I
attribute it to the prevalent custom of dentists to save teeth," continues
the writer. If this attribution proves true it will necessarily revise the
teachings of both medicine and dentistry in the matter of the preservation
of the teeth.
After stating that the apical abscess in his opinion is hematogenous in
origin, and that "The devitalization of teeth, which entails the destruction
of nerve and blood supply to the apex and contiguous bone areas, produces
a locus resistentiae minoris, with lowered oxygen pressure, thereby creat-
ing an ideal nidus for streptococcal growth. We are compelled by the
logic of the situation to condemn all efforts at devitalization by dentists,
and strongly to urge extraction of teeth which need removal of pulp."
He then dtes the findings of Drs. Best and Da\ds who oppose this
view, and who collected 135 cases where the root canal fillings were
done by " other dentists." They reported 1 28 defective root canal fillings
with 103 abscesses. It is perhaps needless to here remark that had these
investigative gentlemen collected cases from among their own clientele,
their contribution to dentistry would have probably been of much more
value.
We would have at least known the method of root canal filling em-
ployed and might have been a littie nearer the solution of the problem.
As it is, their investigations only go to prove that the correct filling of a
root canal by "other dentists" is merely an accident and that 25 out of
128 defective root canal fillings were not abscessed, which should at least
lead us to believe that not all our efforts along this line result in failure.
There is no questioning the fact that Dr. Ulrich has thrown a bomb
into the quietude and prosperity of our professional citadel which calls for
some very thorough and painstaking investigation on our part, the ulti-
mate outcome of which will be watched with deep interest by the medical
as well as the dental profession.
POSTPONED ARTICLES
It has been necessary to postpone the installments of Mr. Supplee's
and Dr. Spies' articles until the May issue. — The Editor.
Digitized by
Google
212 THE DENTAL DIGEST
SUGAR AND ITS EFFECT UPON THE TEETH
By John S. Engs, D.D.S., Oakland, Cal.
{Concluded from March issue)
LIME, MAGNESIUM AND PHOSPHORUS
Before going farther perhaps it would be well to explain that lime
like all other elements of our foods, is held in solution in the blood which
carries it to all parts of the body. The insoluble calcium phosphate is
believed to be absorbed by the blood in the same loose chemical com-
bination with a protein that is found before absorption in the casein of
milk and the yolk of an egg. According to Bunge the casein and caseino-
gen of cow's milk contain more Ume to the litre than does lime water.
** Little is known" he says, "regarding the form in which caldimi exists
in food materials and at present differentiation between the different
groups of calcium compound eaten cannot be made. Metabolism ex-
periments indicate that a healthy man, accustomed to a full diet requires
about 0.7 grams of calciimi oxide per day for equilibrium." Experi-
mental dietary studies have shown that it is entirely feasible to increase
largely the calcium and phosphorus intake by a more liberal use of milk
in the dietary. The same may be said of various milk products in which
the calcium and phosphorus products are largely or wholly retained,
such for example as junket, koumiss, buttermilk or cream. Calcium,
magnesium and phosphorus in proper combination and in sufficient
quantity are absolutely essential to the formation of good bones and
teeth. It is important that the normal amount of calcium and magne-
sium salts should be absorbed by the growing organism during infancy
and childhood, when the skeleton is growing rapidly. The absence of
sufficient fat in the food, and also it is believed, the presence of a greatly
excessive amount, tends to deprive the growing body of its normal supply
of calcium and magnesium salts, and is one of the factors in the produc-
tion of nutritional disorders. Phosphorus, like calcium, is an important
constituent of the bones of the active tissues and also of the body fluids.
Calcium phosphate is the chief mineral ingredient of the bones, and is sup-
posed to constitute about three-fourths of the entire ash of the body. It is
essential for the growth of new tissues that phosphorus should be stored
as well as nitrogen. The importance of phosphorus as building material
is strikingly illustrated by nature, in the way she provides milk rich in
that substance to the young of rapidly growing animals. Not only do
these salts enter into the structure of bones and teeth, but their presence
in sufficient quantity in other tissues is absolutely essential, to insure the
Digitized by
Google
SUGAR AND ITS EFFECT UPON THE TEETH 213
normal functional activities of the most important organs of the body,
particularly the heart. So we see that anything tending to reduce the
normal amount of these three substances available in the blood stream
not only has a detrimental influence upon the osseous system of the body,
but is also likely to have its effect upon the very seat of vitality itself.
ITS AFFINITY FOR LIME
Someone has said that refined sugar possesses a strong affinity for Ume,
and when present in large quantity in solution in the blood stream, it
causes a reduction in the available lime in the blood by combining with
it to form sucrates of lime, so that if food containing sufficient lime is
not taken with our daily meals to maintain the proper balance, the blood
to preserve that balance is forced to extract it from that supply which is
stored up in the bones and teeth thus weakening their structure. This
seems quite plausible, though it is not what we may call a scientific state-
ment; nor does it satisfy the minds of deeper thinkers. It has also been
suggested that the blood may become supersaturated with the sugar in
solution that is consumed in excess of the body needs, and that the blood
being thus surcharged has no room for other food elements required by
the tissues, consequently they are starved. That the teeth can be thus
affected will entail the belief that nourishment of the teeth goes on after
they are fully formed — a fact that some of the more eminent educators
like Black, deny.
METABOLISM IN DENTIN
The word metabolism is used to designate both that building up and
breaking down of tissue which biologists express respectively by the
terms anaboUsm and catabolism. Prof. Torrey of Reed College assures
me that both processes go on together in all tissues. The cataboKc
are particularly obvious in old age, the anabolic particularly obvious
in youth. He does not consider '*old age a bacterial matter." It
seems to him to be '*a definitely metabolic affair; the balance shifting
from a generally uphill to a generally downhill course." Having fairly
good evidence of a constructive metabolism in those cases of hyperdenti-
fication that we frequently find upon examination of teeth subject to
external stimuli — bearing in mind this fact, that both the building up
process and the breaking down, are subject to influences that tend to
throw the balance one way or the other, is it not probable that some such
cause, as lack of proper nutrition, would be likely to shift the balance
towards the breaking down side, and thus cause either decalcification or
degeneration of tissue in the dentin?
That changes in the structure of dentin do occur in completely formed
teeth, is shown in the hyperdentification that results from external stimu-
Digitized by
Google
214 THB DENTAL DIGEST
lation to which they are subjected for long periods of time. We do not
know how or where the lime employed was obtained, suffice it to say,
that some means of conveyance exists. I contend that if lime can be
deposited 'in formed dentin, means for its removal are likewise possible,
should the occasion arise.
Dr. Harvey W. Wiley in response to a letter from me, said amongst
other things, '1 am glad to note that the dentists of the country are be-
ginning to understand that bad teeth are largely due to faults of meta-
bolism, rather than exclusively to heredity and lack of care." He said
also in a previous communication, " I do not believe that dentists can long
hold to the fact that bacterial activities are the sole cause of dental decay.
A condition of acidosis in the body would probably be more effective in
causing decay of the teeth than bacterial activity."
In 1894 Dr. W. G. A. Bonwill read before the N. Y. Odontological
Society a paper entitled **A New Era in Dental Practice." I quote
from it — " Medical men can well ask for preventive medicine, for every
honest M.D. soon learns to give less and less medicine," — *^We, as
dentists have an entirely different field, for we have millions coming to
us where no law of prevention can be applied. We can only save and
restore the lost structure by our cunning and art." *'But there is much
that can be done to check caries in its very indpiency, and that without
fiUing."
** If we must link ourselves at all with the medical men, let us emulate
their example in one thing at least — anticipative medicine or as they
have it, preventive medicine."
While it is true there are "millions coming to us," whose teeth have
yielded so much to the ravages of decay that there seems no hope of
saving them, yet, in the light of modern research and results obtained
in the last few years, I think if we could have Dr. Bonwill with us to-
day, he would not have to say, that *'no law of prevention" can be ap-
plied to them.
If we can but bring ourselves to consider teeth in the same light that
we do other tissues of the body, subject to structural change and under
the influence of those centres that control nutrition, then I think we shall
find a way and a means, to arrest decay in teeth already attacked, and to
prevent it by care in the selection of food for our growing children, seeing
to it that their food furnishes all the necessary tooth building elements,
calcium, phosphorus and magnesium in particular, which are found in
available form in milk, greens (fresh or cooked), vegetables of all kinds,
the unprocessed cereals and fruits and substituting these for sugar, white
bread and cake.
Encourage the manufacturers to produce pure, unadulterated food
Digitized by
Google
A TECHNIQUE OF NATURAL TOOTH BLEACHING IN THE MOUTH 215
preparations, by personally demanding them of your dealer in preference
to the ready cooked, ready chewed and predigested truck that is made
for lazy people.
If we suflfer from tooth decay or any ailment of the teeth either we or
our parents are largely to blame, nine times out of ten. We are given
teeth to use in masticating our food, not entirely for ornament, and
many of us have forgotten how or have never learned to use them. We
have glands that secrete digestive juices but no time is given those juices
to act, food is washed down into the stomach by a deluge of liquid taken
after each mouthful of food before it is properly broken up and mixed
with the saliva.
An extra burden is thus thrust uix)n the stomach, and semi-digested
food lies fermenting in the bowels giving off poisonous elements that
little by little lay the foundation for our old acquaintance, pyorrhoea
alveolaris.
A TECHNIQUE OF NATURAL TOOTH BLEACHING
IN THE MOUTH
By Louis Englander, D.D.S., Philadelphia, Pa.
The restoration and maintenance of a natural live tooth appearance in
a discolored, devitalized tooth is a procedure which has been overlooked
to a large degree by the dental practitioner.
Esthetically, to keep a tooth life-like is a necessity. Especially is this
true of the anterior teeth. Upon it depends in a large measure, the suc-
cess of a porcelain inlay or a synthetic filling. Dentists hesitate to
attempt the bleaching of the teeth, believing that it is only temporary
and that the discoloration will return.
To know the cause of the discoloration will aid in the permanent re-
storation of the color. The enamel is composed almost entirely of inor-
ganic matter and is translucent. It is the dentine which gives the shade
or color to the teeth. The dentine is composed of a solid organic matrix
containing a large percentage of inorganic matter. This is pierced by
minute canals or tubules which radiate from a central cavity. The
minute canals or dentinal tubules are occupied in life by protoplasmic
processes from the odontoblastic cells which form the outer layer of the
pulp. It is in these tubules that the discoioratioa occurs, and into which
the bleaching agent must penetrate.
The discoloration of dentine is due to three causes; hemoglobin, me-
Digitized by
Google
2t6 THE DENTAL DIGEST
tallic and carious. When extirpating the pulp, espedally if the tooth
has been opened from the side or back, care must be taken that all of the
hom of the pulp is removed. Any blood resulting from an apical hem-
orrhage and all carious d6bris must be thoroughly removed mechanicaUy.
\fter this has been accomplished, we may then enter upon the bleaching
of the tooth.
As a bleaching agent, the writer has found that either Dioxygen or
Perhydrol is the most convenient and satisfactory to use, and, if manipu-
lated proi>erly, success will result in all cases. In using Dioxygen place
about one and one half fluid drams of the H2O in a test tube and heat
slowly over a small flame of a Bunsen burner, holding the test tube at an
angle of about 30 degrees, and concentrate the fluid to about 10 minims.
Some of this is then placed in the tooth cavity on a small pledget of cotton.
Several blasts of hot air are blown upon it in the direction of the greatest
discoloration. Repeat this operation two or three times. Where a
compressed air blast is used, be very careful not to direct the hot blast
against the enamel too long, as it will burn the enamel and produce a
brown discoloration which cannot be removed. If the color is not re-
stored at one sitting, place a pledget of cotton containing the concen-
trated H2O2 in the cavity and seal it up with temporary stopping or
cement. Have the patient return in about five days and the improve-
ment in color will be manifest. In case the restoration of shade has not
been complete, repeat the operation. Three such treatments usually
suffice.
Perhydrol (Merck) is about 30° H2 O2 by weight, and has the advan-
tage over Dioxygen in that it can be appUed without boiling. Should
the Perhydrol become weaker through age, it can be boiled and the
strength regained. In using either Dioxygen or Perhydrol, it is advisable
to place the rubber dam over the tooth to be bleached, and also to be
careful not to get any on the fingers, as these strong bleaching agents
attack the tissues. Never apply either of these strong medicants to a
vital tooth.
Now that the dead tissue in the dentinal tubules has been bleached,
and the desired color restx)red, the tooth should be wiped out with alcohol,
thoroughly dried, and a light yellow cement placed directly against the
dentine, which will seal the tubules. For this I have found Harvard
Cement No. 4 most suitable. The tooth can then be filled with whatever
material desired.
I have cases under my observation which were treated in this manner
more than eight years ago, and they still have the same live tooth appear-
ance.
Digitized by V:iOOQIC
ADJUSTING OBTURATORS
217
ADJUSTING OBTURATORS
By J. E. KuRLANDER, D.D.S. AND H. J. Jaulusz, D.D.S.
Cleveland, O.
In making and adjusting obturators to remedy the inconvenience of
patients afflicted with cleft palate, not only should the dentist know the
history of the patient and the causes which bring about this condition,
but by careful study of the case in hand he should form some idea of the
part which the five pairs of muscles controlling these parts play in their
impaired physiological functions. These muscles as well as those of the
tongue, the hyoid bone and the pharnyx, take part in deglutition, pre-
venting the food from passing into the larynx and nasal cavity and in
forcing the same into the oesophagus in the act of swallowing.
Elus. No. I. Impression of cleft in plaster
Cleft palate may be divided into two classes, namely, congenital and
acquired. The first or congenital is brought about either from deficiency
in the supply of lime salts to the maxillae of the foetus, thereby produc-
ing malformation of the parts and that in the absence of any diseased
condition brought about by syphilitic taint on the part of the parents.
Acquired cleft palate is brought about by wounds inflicted on the parts,
as well as from niunerous other causes. In the case under consideration,
the cleft in the palate was due to hereditary syphilis.
The patient, a young man 22 years of age, came to me with a V-
shaped cleft which widened posterially, the uvula and about two-thirds
of the palate processes of the superior maxillae being absent. His
speech was so indistinct that it was with diificulty that he could be under-
stood when talking, the sound passing through the nose. He was also
greatly annoyed by food passing through the deft into the nasal fossae
during mastication and deglutition.
Digitized by
Google
218
THE DENTAL DIGEST
nius. No. 2. Gold crowns adjusted to the two superior bicuspids with platinum posts
soldered on
Dlus. No. 3. Side view of obturator, showing hinge
Illus Nq- 4- View of plaster model with obturator in place
Digitized by V:iOOQIC
THINGS THAT ARE SAID IN DENTAL JOURNALS 219
T first took an impression of the cleft in plaster; removing this I filled
the deft with soft wax and took a plaster impression of the mouth.
Having taken these two impressions, I made and adjusted gold crowns
to the two superior second bicuspids — to the palatine surface of each of
which a platinum post about an inch in length was soldered. Taking
another impression with the crowns adjusted, I made a model of same
and casting an aluminum plate formed grooves in the palatine surface of
it, in which the posts on the crowns would fit, and which helped to sup-
port the plate in position.
I next made an extension to the plate to fill in the cleft posterior to
it and to substitute the absent uvula, making the same of aluminum,
which was also cast. I made a gold hinge, one-half of which was vul-
canized to the heel of the plate and the other half to the anterior edge of
the extension. On the anterior palatine edge of the extension was a pro-
jection of aluminum, which when the plate and the extension was in the
mouth, caught on the end of the gold post which was vulcanized to the
palatine surface of the heel of the plate, and thereby prevented the forc-
ing of the extension by the muscles too far into the post nasal vault.
The protection which this applicance when in position afforded the pa-
tient in mastication and deglutition were complete, and his speech was so
greatly corrected that he could be plainly understood when talking, and
he was transformed from the village fool, as he was called, to a man
whose speech was so fully corrected as to render any impediment in it
scarcely noticeable.
2496 E. 9th St.
THINGS THAT ARE SAID IN DENTAL JOURNALS
By Hillel Feldman, D.D.S., Bronx, N. Y.
It seems there is no limit to the things that some professional men can
get themselves to say in a Dental Journal.
In the January issue of the Dental Digest "W.B.B." asks "what is
the best thing to do for a child three years old who breathes through the
mouth nights and snores as loud as an adult? "
In the February issue followed a short note in answer to ''W.B.B."
from the pen of **Levi C. Taylor" which is the cause of my writing this.
The February correspondent gives "W.B.B." the very elegant coun-
sel of binding the child's lips with adhesive plaster, '* tight," so that the
child will be compelled to breathe through the nose! Presto! Doesn't
that solve the question? Truly ''the pen is mightier than the sword"!
Digitized by V:iOOQIC
220 THB DENTAL DIGEST
(Why not melt paraffine over the adhesive plaster so as to make an herme-
tical seal out of the operation?) In the morning, behold, Levi C. Taylor
says *^you remove the adhesive plaster by taking hold of one comer."
Isn't that an advance in scientific research?
I sometimes wonder why the medical professional holds in such light
esteem the members of the dental profession. How, pray, can I censure
them when they read such edifying epistles from dentists as the reply to
''W.B.B."?
If W.B.B.'s patient breathes through the mouth at night, a good
rhinologist should be consulted. The latter may find it necessary to
further invite into the consultation, an orthodontist. I am sure it is a
simple physical defect that can be remedied. But until it is remedied the
child's breathing should not be interfered with by any such outlandish
methods as plastering up the mouth. Breathing through the mouth is
not a voluntary, acquired, habit, but rather a condition forced upon in-
dividuals by physical imperfection of the naso-pharynx, constriction of
the ajtiterior nares with attendant constriction of the bones of the anterior
area of the face, or from deflected nasal septum, to say nothing of the
presence of adenoid growths in the posterior passages.
HARTFORD MEN CONTRIBUTE TO FORSYTH LOVING CUP
In an editorial in the Oral Hygiene magazine, edited by W. W. Belcher,
D.D.S., of Rochester, an article appeared asking that all dentists send
not over 25 cents for the purchase of a loving cup to be presented to
Thomas A. Forsyth, as a testimonial of the esteem in which he was held
by the dentists.
A list of the dentists in Hartford was prepared and presented to each
as far as known. If all the dentists in our different cities and towns
respond as quickly and in such numbers as the city of Hartford, the
loving cup will certainly be presented to Dr. Forsyth very shortly.
Editor Dental Digest:
Can any of your readers give a remedy for a baby sucking her lips?
JS.
Editor Dental Digest:
Will some of your readers please give a formula for cleaning impres-
sion trays?
Perplexed.
Digitized by V:iOOQIC
NEW METHOD OF CONSTRUCTING FULL DENTURES 221
NEW METHOD OF CONSTRUCTING FULL DENTURES
By Clyde Davis, D.D.S., Lincoln, Nebraska
I have a method which I wish to give the dental profession for its
consideration, of constructing a full denture, either single or double, that
I have never read of and I believe the idea or the application of the idea
is original. I have tried it out in our infirmary and proven that it is
possible to get suction for all plates, both upper and lower, in every in-
stance where the mouth approaches normal.
Stated in a nutshell, the method involves the complete abandonment
of the model of the mouth and the plate is vulcanized on a cast which
is the negative of an adhering base plate. Given as briefly as possible
the method is as follows.
An impression is taken of the mouth and the cast made, which should
be somewhere near correct, but it is not necessary to take any great
pains with it. It should give the outline of the completed plate and par-
tially represent the conditions of the mouth. In fact, in some instances
even this is not necessary provided you have a dummy cast of plaster,
metal or celluloid, which is somewhere near the size of the mouth, but
should be a trifle larger in every direction. Having secured an approx-
imately correct model a specially prepared base plate which is very thin
and when warm is very pliable, is readily shaped over this model. This
base plate will probably not show suction when placed in the mouth and
pressed to position. If it is far wrong, take it out, warm it over a flame
and press to place in the mouth. As soon as a little suction begins to
show up, instruct the patient to keep the mouth closed and suck the
plate as tightly as possible. The warmth of the mouth will change this
until close adaption results and strong suction will appear. This may be
assisted by manipulating with the fingers and it is particularly necessary
with the trial base plate on the lower jaw. When this suction has been
secured it will be found that this trial plate will not fit the original cast
even though it is a perfect model of the mouth. It will be found that no
impression of the mouth can be taken which this adhering base plate
will fit, which proves my contention of the past twenty years, that a
plate made from a perfect cast of the mouth seldom has adhesion. I have
always spoiled my casts up to this time in order to get adhesion. Now I
am asking you to throw them away altogether.
Coming back to the case where you have one or both adhering trial
base plates in the mouth, I then take the bite in the usual way for that
kind of a case using the built up bite on these base plates. Plaster of
Paris is then mixed up ready for use and the trial plates hastily removed
Digitized by
Google
222 THE DENTAL DIGEST
from the mouth and filled with plaster. These are then mounted on the
articulator and the case proceeds in the usual way. In these casts which
are poured up you have the negative of an adhering base plate which .
is by no means a model of the mouth. Every plate made by this method,
both upper and lower, adheres as would the trial base plates. This method
of making an adhering denture without vulcanizing on a cast of the mouth
has many side issues which I haven't time to go into at present. SuflSce
it to say that by this method we can construct a denture, if necessary/
without having taken an impression of the mouth, using an approximate
dijjnmy to start the shape of the base plate, completing its form in the
mouth assisted by the body temperature which must slightly affect the
specially prepared base plate. The plaster which is poured into these
adhering base plates should be a little below body temperature in order
that they may not give and change shape under the weight of the poured
in model. The base plates should be given a thin coat of quickly drying
ether varnish, before pouring the plaster and then painted over with a
very thin solution of soap. This gives a smooth cast and the base plate
by warming can be easily removed from the cast. This matter can be
tested out by anyone if they will try the base plate back in the mouth
after it has been removed from this cast and it will be found that the
adhesion is still there. If you will take the base plate and warm it and
place in over the original cast of the mouth and press it into place and
then try it in the mouth, it will be found that the adhesion has been de-
stroyed. Allow this base plate to remain in the mouth and get warm, and
adhesion again takes place. Taking it out of the mouth it will be found
to fit the cast which has been poured into the base plate and does not fit
the cast of the mouth.
You will see more about this method later on.
University of Nebraska
CARE AND USE OF THE TOOTH BRUSH
Pour boiling water on your brush occasionally. Keep it in a large
mouth bottle in which you have a saturated solution of boric acid Make
new solution once a week. Request your patients to bring their
brushes to the office with them and you take the brush, holding it prop-
erly in your own hand, and brush their teeth. You can teach them
the correct use of the brush no other way so well. Be very sure you
are capable of teaching this important truth. It is an acknowledged
fact that improper use of the brush is but little better, if any, than no
use at all.
J. M. Prime.
Digitized by
Google
INDICTMENT AGAINST DENTIST QUASHED 223
INDICTMENT AGAINST DENTIST QUASHED
{Federal) The vigilance of the government in putting an end to the
drug trafl&c in the United States is presented in a large variety of recent
cases. Among them the case of United States v, Freedman stands out
prominently. Defendant Freedman, a dentist was indicted for having
dispensed morphine sulphate in other than the regular course of his pro-
fessional practice, that is to say he used the drug in quantities more than
was necessary for a patient's use.
The defense interposed was that the law contained no language
governing the question of necessary quantity. The law in specific terms
enumerates the requirements imposed on those who handle the drug in
making a sale, such as filing a dupKcate with the Commissioner of Internal
Revenue, etc., but nothing is said with relation to selhng or using the
drugs in quantities more than necessary to meet the needs of a patient.
The court quashed the charges against the defendant. Quoting the
court, Judge McCall said: "I fail to find in the act of Congress under
examination any language making the doing of the things with which
the defendant is charged a violation of law. In other words, there is no
limit fixed to the amount of said drugs that a physician, druggist or
dentist may prescribe, nor is there any duty imposed upon him, and the
name and address of the patient, except those to whom he may personally
administer, and that he must preserve the records of two years. For
failing to do either of these things he is not indicted." The indictment
was quashed. (United States v. Freedman, 224 Fed. 276.)
EXCLUSION OF POISON FROM MAILS
(Federal) Post Office Department Order No. 2923 by the Post-
master General prohibiting the mailing of poisonous compositions except
for transmission in the domestic mails from manufacturer or dealer
to licensed physicians, surgeons, pharmacists^ and dentists, held invaUd,
as beyond the jurisdiction of the Postmaster General. (Bruce v. United
States, 120 C. C. A. 370.)
VETERINARY DENTISTS AMENABLE TO THE GENERAL DENTAL LAWS
(North Dakota) The North Dakota Supreme Court has, by a recent
decision, held veterinary dentists to be subject to the North Dakota
Laws having application to other dentists. It is quite clear that the
legislative intent was to afford to animals the same degree of surgical
skill as is by the state dental laws guaranteed to man. The defendant in
State V. Ramsey was convicted in the County Court of Cass County of
the crime of wilfully and unlawfully practising veterinary dentistry with-
Digitized by
Google
224 THE DENTAL DIGEST
out a license. He was a student under a Doctor Milan. It seems that
defendant performed all dental work under Doctor Milan, doing the
mechanical work such as extracting teeth and filling them.
Defendant's contention was that he was immune from the law in
view of the fact that he was not engaged in the profession of dentistry
as conmionly understood but in the profession of veterinary dentistry
and that as the law makes no specific reference to veterinary dentistry
it was not intended to have any application to such profession.
The defendant was convicted in the trial court it having been held
that he was subject to the general dental laws. On appeal, the Supreme
Court affirmed the holding of the lower court. (State v, Ramsey, 154
N. W. 732.)
FRAUD ON MEDICAL EXAMINERS PUNISHABLE
(Iowa) The Iowa Code provides that any person who shall present
to the board of medical examiners a fraudulent or false diploma, or one
of which he is not the rightful owner, for the purpose of securing a certi-
ficate permitting him to practise medicine or dentistry or shall file or
attempt to file with the county recorder the certificate of another as his
own, or who shall falsely personate any one to whom a certificate has
been granted, or who shall practise medicine, surgery, or obstetrics or
dentistry without obtaining and filing the required certificate, or who
continues to so practise after the revocation of his certificate, shall be
guilty of a misdemeanor.
Under this law one Charles Edmund was indicted for having loaned
his certificate to a fellow named McAninch. McAninch proposed to
practise under such certificate. Edmund and McAninch were both
tried and convicted in the same trial. This Edmund claimed to be error
on the part of the trial court. The Supreme Court on reviewing the case
however held that such procedure was regular. (State v. Edmund, 154
N. W. 473.)
LICENSE LAW CONSTITUTIONAL
(Wisconsin) The statute providing for the licensing of all persons
practising medicine, surgery, dentistry or osteopathy for fee or compensa-
tion and imposing a fine for practising without a license is constitutional
and within the legislative power. (Arnold v, Schmidt, 143 N. W. 1055.)
SELLING MORPHINE WITHOUT PRESCRIPTION
(Georgia) One who sells morphine not on the order of a licensed
physician, dentist, or veterinary surgeon, is guilty of a misdemeanor,
whether he is the proprietor of the drug store, or merely the employee of
such proprietor. (Oppenheim v. State, 77 S. E. 652.)
Digitized by V:iOOQIC
FIRST UNIVERSITY DENTAL SCHOOL FOR COLUMBIA 225
FIRST UNIVERSITY DENTAL SCHOOL IN
NEW YORK FOR COLUMBIA
Dental Course to be Allied with College of
Physiclans and Surgeons
Realizing the importance of the teeth and mouth infections to sys-
temic disease, the Faculty of the College of Physicians and Surgeons have
unanimously voted in favor of the establishment of a dental department,
to be connected with the medical school. A committee of prominent
dentists of the .dty have presented plans to the Medical Faculty which
have been approved.
The school of dentistry will be closely associated with the medical
school and the admission requirements will be the same as the medical.
The course will be four years, the first two years the same as those in
medidne, thus giving the dental student a thorough knowledge of the
fimdamental sdences necessary to the practice of a spedalty of medidne.
At the end of the second year the dental student will give all his time to
the study of dental subjects, namely, operative dentistry, prosthetic
dentistry, oral surgery and oral pathology, orthodontia, etc., and the more
technical part of the work required for the well trained dental surgeon.
This new school will be the first university dental school in New York
City and the second in the State. It will give the first four year course
of dentistry ever given in the Empire State.
DR. WILLIAMS NEEDS TEETH
In the course of our studies in tooth form, we have need of a good
many natural anterior teeth, not decayed to an extent which destroys the
form.
If you have any such and wish to aid Dr. Williams in his work for the
benefit of the whole profession, will you not please forward them to Dr.
J. Leon Williams, in my care? I will gladly pay the express charges or
refund any postage you may paiy.
The importance of this request is seen when it is remembered that it
was such a contribution of teeth from Dr. Friesell, that enabled Dr.
Williams to put his discovery of typal forms into definite terms.
George Wood Clapp.
Digitized by
Google
(TINE^BVILDING
The only business which is good busi-
ness is that business which tends to build
the man while the man is building the
business. — ''Neptune'' — Nebr, Dent, Jour,
WHAT SHALL WE CHARGE FOR PLATES?
By W. J. HoLROYD, D.D.S., Pittsburgh, Pa.
Whoever shows us what it costs us to render professional service,
benefits each of us who is not doing himself justice and each patient who
is not receiving justice in the form of adequate service.
A long study of this subject of patients, service and fees, has con-
vinced me that when dentists are sufficiently paid to permit them to do
their best for each p>atient, we shall see such a wave of technical advance-
ment as no generation of dentists has yet witnessed. Here and there a
man is divining his opportunities and rising to his possibilities. Ac-
quaintance with several such cases shows that the p>atients are even
more delighted with the results of such a course than are the dentists
with the increased income.
Dr. Holroyd's figures deal in a practical way with one phase of service
which greatly needs such treatment. Answer him if you wish, but first
time yourself on work well done, that you may know whereof you speak.
— Editor.
FOREWORD
From a high authority — President Pritchett, of the Carnegie Founda-
tion— we leam that the medical profession scarcely pays now, and tends
to pay even less. "It is becoming more and more a profession to which
men give themselves from ideals of public service, recognizing that the
average practitioner is to obtain little more than a comfortable living,
and in many cases not even that. The parent who seeks for his son a
remunerative occupation should look elsewhere."
Everybody knows that teaching does not pay and preaching pays
still less, while literature — if you measure the tcftal bulk of the time
expended against the gross receipts — represents a positive deficit. There
remains the law, in which a sufficiently agile youth may now and then
overtake a fortune, but the grand prizes are few and the average income
is about equal to that of a good carpenter.
Dentistry may be classed with the above.
Thus, of the old professions, none pay. A diligent and skilful man
may make a comfortable living and keep up the premiums on his life
insurance. Why then do practitioners of the learned profession persist
Digitized by
Google
WHAT SHALL WE CHARGE FOR PLATES 227
in trying to make them pay? How much they might simplify pro-
fessional life by going in frankly for '* ideals of public service" with a
reasonable pension! Probably there are more furtive Socialists among
professional men than professed ones among workingmen.
So much for Prof. Pritchett.
From the above it would seem that the men in the professions have
not a very desirable financial outlook for the future. It does not be-
hoove dentists to stay dormant, but to agitate a movement wherein such
conditions may be remedied. We cannot pretend to do it in the other
professions, but we can help our own to a very material extent — treat
it as merchants treat bad conditions in their business — by analysis, con-
trast, and comparison. We can get at the cause and then outline a
policy that will bring order out of chaos.
The habit of "Studying the Cost of Conducting a Business," is going
on all over the country. It is only right that we dentists should fall in
line and study our own profession, with a view of securing for ourselves
proper remuneration, because if we don't we shall go to the wall. A man
is more sure of himself, and has more confidence and poise in quoting
prices, if he knows what he is talking about. A man who has '* timed''
himself on different operations knows why he is asking a higher price for
work than the dentist who charges a certain price for no other reason than
that it is the custom. Considering that a dentist of lo years* standing
is only averaging $1,250, nel income per year and the cost of living still
going higher, a thinking dentist realizes that something must be done, in
order to hold his footing among men of the same standing in other voca-
tions.
There has been an awakening all over the country among the dentists,
in regard to the right minimum prices of different pieces of work manu-
factured by the dentist and an earnest demand for authentic data to
work from has been vigorously solicited.
Dentists want to know. There are now some live men in the pro-
fession and they are no longer content with just making no better living
than a carpenter, a bricklayer, or a draughtsman. Considering that they
have spent so much money and time for their education and have more
responsibility, being dentist, educator, salesman, and bookkeeper, they
are justified in wanting more remuneration than the artisan whose
responsibility is shouldered by his employer.
Dentists have a right to know what fees they are entitled to and until
they do, dentistry will not stand where it belongs, for in order to attract
the best brains to it, it must also be possible for a man to make something
more than a living.
Digitized by V:iOOQIC
228 TH£ DENTAL DIGEST
Only I per cent, of the men in our profession to-day are highly
schooled. Why should a business man who has gotten along to where
he can afford to send his boy to common school, high school, preparatory
school and then college, let that same boy after all that education, take
up a profession that yields approximately only $125 a month after being
10 years in business. You would not let one of your own boys do it.
You would say yourself, *'No son, after all that schooling, you must take
up something that will yield better returns. " Thus we have an instance of
a highly cultivated brain being lost to the profession. In a Yale graduat-
ing class of 300 or more — 160 proposed to be lawyers; the rest were
divided between medicine, architecture, engineers, etc.; not one of the
whole class said he would take up dentistry. True, some dentists have
made signal financial success without business education, but they
did it in spite of non-education, not because of it. How infinitely better
might they have been had they had that education. We all regret it.
Therefore we must get better remuneration for our work, if we would get
this class of man into the profession.
Times are changing more rapidly now than ten years ago and dentistry
is also changing very rapidly. The average dentist cannot keep up with
it. It costs every dentist more to-day to conduGt business than 10
years ago and still his prices for work remain the same, and he has
to do more work to make it up. Right there he is going back — out of
date. Therefore, we are going to show him how he may help himself.
Remember these words throughout all of this article — Contrast and
Comparison — everything is governed by it. If a man were on an island
and he had no one to compare himself with, he would not know whether
he were stout or thin, long or short, strong or weak, fast or slow. We
don't know whether a building is tall until we compare it with another,
or whether our salary is large or small unless compared with someone
else, and so on down the list. The world is governed by contrast and
comparison a thousand times a day. They are all about us and men use
them constantly in the day's work — that is, all men but dentists. It
does not seem to have entered their craniums as yet.
We are going to contrast the wearing value and prices of our work,
with the value and price of other goods tendered by merchants, weighing
service for service. Contrast the following:
If a patient pays $30 for a suit and it wears for one season, why should
he expect your $30 piece of work to last 10 years.
If you buy two pairs of shoes at $5 a pair and they last one year, why
can't you ask $10 for a good gold crown, lasting 10 years?
If a workingman pays 50 cents for a theatre ticket, for one night, he
can afford to pay $3 for a good amalgam filling, lasting 10 years.
Digitized by V:iOOQIC
WHAT SHALL WE CHARGE FOR PLATES
229
If a lady in ordinary circumstances can aflford to pay $75 for a medium
class set of furs, which she only wears a few hours per week for four
months a year, she can afford to pay $60 for good, well articulated, care-
fully made dentures, which she wears all the time, and on which she
will eat 10,000 meals in 10 years.
Contrast and Comparison — ^ponder it. Open your eyes.
According to Dun's report, the expense of living has gone up 50
per cent, in the last 10 years. This includes the living of dentists, also.
That is, your $150 only goes as far now as $100 did 10 years ago, and if
your prices in dentistry remain the same you have to work half as hard
again to accomplish the same results, in a given time as you did 10 years
ago. Think about this.
Even if you had raised your prices 50 per cent, that $5 crown to $7.50,
$15 plates to $22.50, 50 cent extractions to 75 cents, and so on, you would
only be in the same position as you were 10 years ago, and not advancing
any. As it is you charge the same prices and have to work half as hard
again and then you just stay in the same place. No gain as your reward
In fact you are going back, because you cannot save anything and are
getting older.
Let me give an instance in our own profession by comparing some of
the expenses of two offices of 10 years ago and to-day.
1902
191 2
Rents 33 % more
Telephone ....
None
Telephone . .
$ so per yr.
Office girl ....
$ S per wk.
Office girl . .
8 per wk.
Foot engine ....
36
Electric engine
150
Foot lathe.
16
Electric lathe .
35
Brass cuspidor . .
3.50
Fountain cuspidor
40
Dental chair ....
125
Dental chair
i8s
Cabinets
60
Cabinets . .
150
Foot Bellows ....
5
Compressor
12
Porcelain furnace
None
Porcelain Furnace
100
Switchboard . . .
None
Switchboard with appliances 250
Typewriter ....
None
Typewriter . .
100
And so on ad infinitum. The list could be made much longer, but the
above is enough for example. In the office described in the first column,
such equipment was not looked upon askance 10 years ago, but woe
betide the up-to-date man of to-day who has not the articles in the second
colunm. He cannot claim to be up-to-date if he hasn't them, as they
are now necessities. But few men have them, because most men can't
afford them. The prices gotten in their practices do not justify the
outlay. They haven't any money left. Some dentists are up-to-date
enough to go to conventions, where the Dental Manufacturers have their
exhibits and look with envy upon the new appliances designed by experts
in the profession. They would like to bring their offices up to date, yet
they keep on plodding at their work in the old way, never dreaming that
Digitized by V:iOOQIC
230 THB DENTAL DIGEST
they can alter their patients' viewpoint just as other merchants have
altered their patrons' viewpoint.
Remember the merchants have spent thousands of dollars educating
people to imderstand, appreciate and follow the styles. There used to be
summer and winter clothes — we all remember them. Now, there are
four seasons and they have even stopped the ladies from interchanging
their dresses — they have now to dress in ''tones." This "education**
includes dentists' wives.
FOR DENTISTS
Financial success is all a matter of educating the patient and studying
costs, and raising prices so you can buy these new labor saving appliances
and become up to date. Remember that the manufacturer is the man
who places the price on everything in your office. You were told the price
and you paid or left it. But the majority of dentists allow their patients
to quote the price of work. We are not salesmen, just mere order takers.
Patients say the price is too much and we cut the price to suit their
pocketbooks — in the face of the fact that they are paying other manu-
facturers $1 where we get 25 cents.
Now it has been proven that to maintain an office as above (2nd col-
umn) and constantly keep in touch with new improvements, takes 50
cents on the dollar of gross receipts at present average prices, before the
dentist has anything left for himself. To make a larger percentage on
the dollar, he will have to charge more all along the line for his work. To
do this intelligently he will have to go to the trouble of ** timing" himself
during different operations. If he does that, he will not need any one
to beg him to change his viewpoint.
All business men and manufacturers put a price on their product,
based on quality of labor and the ti?ne it takes, and no trouble is too great
that enables them to get results. They sit up nights and have meetings
and call in cost experts to help them. This brings us to the analysis
of the heading of this paper.
What should we conscientiously charge for plates — what should be
the minimum price?
Some time ago, we sent broadcast to 35,000 dentists, through the
Courtesy of Oral Hygeine^ a time chart for plates, asking dentists to
fill in the time required for the different steps and return to us for com-
pilation and averaging. We have received a great deal of help and this
article will give you the results. Although it emphatically demonstrates
that the dentists need to be taught how to do things for their own good,
some men must have thought the timing was intended to be a race — to
see how quickly they could do a certain specified piece of work — ^and some
Digitized by
Google
WHAT SHALL WE CHARGE FOR PLATES 231
again have been very conservative and have gotten together a very fair
average of "times.*'
The timing of operations means an average of many times (say 20),
and when a man writes that he can paint an impression, pour model and
mix his plaster right, so that it has no bubbles and every particle of
plaster comes in contact with water in two minutes and then separate
and build up trial base plate, according to the latest accepted standard,
in three minutes, and at this rate make a whole upper denture in i hour,
47 minutes, then his records are not to be put down to average with
other conservative men, who do the work more thoroughly. Such
timing is not correct and it is a reflection on the compilers' intelligence to
quote his figures in averaging.
The average time from more than 150 reliable statistics results as
follows:
CHAIR TIME
Time consumed in making contract for plate:
Examination and consultation 30 minutes
Taking impression 15 "
Taking bite 20 "
Trial plate fitted 30
Fitting denture in mouth 15 "
There shows an average of 4 trips for plate to be adjusted, sometimes to be
scraped and troubles at other times imaginary, but consuming time about
20 minutes each visit 80 **
LABORATORY TIME
Painting impression and pouring model 12 minutes
Separating and making trial base plate 20 "
Mounting on articulator 10 "
Selecting teeth 15 "
Articulating 46 "
Final waxing 25 "
Investing 20 "
Packing, putting in and taking from vulcanizer. (Does not include time for
actual vulcanizing) 90 "
Scraping and polishing 60 "
60)488
8 hrs. 8 min.
Percentage of makeovers 25 per cent 2 "
10"
These times are compiled from quite a number of dentists and prove
that work can be averaged to such an extent that a basis of price can be
arrived at. Remember, this sending out to 35,000 dentists for data was
never done before, and proved quite a task and if any skeptics differ with
any of the above statistics, I shall be glad to be corrected if they will go
to the same amount of trouble.
Digitized by
Google
232 THB DENTAL DIGEST
Now if it takes 50 cents on the dollar to conduct an up-to-date office
and if you only charge $20 for a plate and it takes you 10 hours to make
It, you can readily see that it costs you $10 to make that plate, counting
material and overhead expenses (which lots of dentists never think about),
leaving practically $1 per hour for yourself, which sum a jobbing plumber
demands when he comes to open your sink. A tile setter gets 62^ cents
per hour. After spending your money and 3 years for education and tak-
ing all the responsibilities of business worries and building up your prac-
tice, ask yourself if you are not worth more than $1 per hour net. Some
of the mechanics' wages are only a few cents less per hour and they have
no overhead responsibility.
You might say the laboratory does a lot of it and it is really not your
time. I can get a plate made for $3 and charge $15, that is $12 profit.
This way of figuring is not right. Too many dentists figure that way.
Overhead charges and running expenses must be put against the first
price, and considering that the dentist is made responsible for any work
that does not fit and any makeovers must come out of his own pocket,
he must charge and receive the profit as if he had made the whole plate
himself. If the dentist has to stand the brunt of mistakes of other
people whom he employs, he at least is entitled to the profits of their
labor. It is so all over the conunercial world. A dentist of 10 years'
practice should be earning $6 per hour gross — earning $3 net per hour.
Another point of vital importance. It has been conceded, after a
lengthy canvass of the foremost men of the profession and accountants
and cost experts on the side, that highly specialized laboratory work
should command as much pay as work at the chair.
This special problem of whether the laboratory charges should be
charged at the same price as chair time was put up to the representative
of one of the largest cost expert firms of Pittsburgh, who handles the
business of large corporations, and his decision, after giving the point
much thought, was decidedly in the affirmative. Large law firms do it,
the work of subordinates' work is charged the head of the firm's prices, and
the head of the firm takes the responsibihty. The principle is the same
in our case. Other instances can be given in architects' and engineers'
offices, etc., which proves enough precedent, and considering that these
cost experts have studied such points as these and that these decisions
are accepted by banks and the commercial world in general, we are only
showing our ignorance by doing otherwise. Such a course will only
prove our undoing.
It has also been brought out in another paper that the productive
time in an office for one year is only / fioo hours ; the dentist may be in his
office 2,500 hours but the losses, including time exceeding that con-
Digitized by V:iOOQIC
WHAT SHALL WE CHARGE FOR PLATES 233
tracted for, makeovers, times for consultations and charity work —
cut down the actual producing hours to an alarming extent. One thou-
sand hours have to stand the brunt of the charges.
Therefore, the foregoing brings us to the crucial point that lo hours'
work on a single vulcanite plate at $6 per hour is $60, which is the mini-
mum price that ought to be charged, gold plates in proportion, con-
sidering the knowledge which is put into a properly fitting denture.
This leaves $30 for yourself.
This price, gentlemen, is what single rubber dentures will bring when
the dentists wake up to the cost of conducting their practices and a
knowledge of what is their due. There are more dentists who have
realized these facts and are charging these prices than you would imagine,
and at that, the patient is not paying one whit more than he pays for
other things, considering value dollar for dollar. The poor man who
scrapes his money together and pays $250 for a piano pays the salesman
$125 profit. If it takes the salesman one hour to sell him that piano that
workingman pays him $125 for one hour's work and that salesman does
not shed any tears over it either. The poorest working people can and
do afford and pay the various dealers a bigger rate of profit for various
articles than they do the dentist, considering the length of service ren-
dered. It is estimated that the dentist only asks 25 cents on the dollar
compared with other men in other business. Yes and even less. Instead '
of being called D.D.S. we ought to be called D.P.P. — ^Department of
Public Philanthropy.
It is not just, considering the knowledge required, that a dentist
should receive only the pay of a good workingman or artisan. This
fact explains, as a Dean of a college once said, why after 5 years a good
many graduated dentists drop out of practice into other callings. A
good many dentists in the farming districts, who complain of cheap
prices, claim their class of patients could not pay these prices, but do
you find the merchants of the city reducing prices of farmers' neces-
sities on that account? The farmers pay the merchant the same price
and ratio ot profit as does the workingman in the city. Every other line
of business from pins to automobiles is now controlled by interests that
have educated (a little at a time) the masses (including dentists) to pay
considerably more than was paid 10 years ago. That is an accepted fact
but the prices of dental work have not changed to an appreciable extent
in the last 15 years .
It bespeaks a lack of business acumen and a laxity in keeping up with
the times on the dentists' part. Dentists may protest and say proper
fees can't be gotten, but they are being gotten by the ones that are
"waking up," who are determined to secure a competence in their old age.
Digitized by V:iOOQIC
234 THB DENTAL DIGEST
A word about this competence. A competence is at least $30,000,
which yields, at 4 per cent., $1,200 yearly, or $100 a month. Ask your-
self, have you got it or are you saving it? If you are saving anything
at all it is not from making plates, and it behooves you to study which
department of practice you are losing money in, and plates is one of them.
The remedy is — start to-day. When the next patient for a plate
comes to you, do not give him any limit, say (to start the propaganda)
that he can have any price up to $60, and then he will naturally want to
know the difference, then show him the anatomical articulator, the new
rubbers and the new teeth and it's up to you to work the salesmanship
stunt just as it is worked on you. Don't keep on quoting $10, $12, and
$15 eternally. Sell service and you will be surprised within six months
what a material change you can bring about among the very people you
are now working for. Start to-day and then shortly you will be able to
fit up an oflSice such as you have dreamed of — and keep things going along
these lines.
PROOF OF MALPRACTICE IN DENTISTRY
In recently affirming judgment, a Chicago dental company in favor of a
patient for $1,000, as recovery for injuries claimed to have been sustained
by the latter by reason of negligent performance of dental work done for
her by defendant's employee, the Illinois Appellate Court decided that
malpractice was sufficiently established by proof that the employee
negligently bored through the roots of four of plaintiflF's teeth into the
alveolar process or bony tissues of the jaw, thereby causing a painful
condition, which required long treatment and rendered impracticable
the placing of a permanent dental bridge. Incidentally, the Appellate
Court held that it was not improper to permit an expert witness to testify
in plaintiff's favor as to the condition of the bore in plaintiff's teeth the
year following the treatment by defendant's employee, without requiring
plaintiff to first show that no one else had treated the teeth in the mean-
time, since it was open to defendant to show that the condition of plain-
tiff's teeth was aggravated by anything for which defendant was not re-
sponsible, if there was any such aggravation.
A. L. H. Street,
St. Paul, Minn.
Digitized by V:iOOQIC
ANSWER TO A REQUEST FOR ADVICE 235
ANSWER TO A REQUEST FOR ADVICE
I am opposed to any advertising which makes any mention of the
dentist's personal skill, special methods, etc.
I don't believe the restrictive adjectives "fraudulent" or "mislead-
ing" as applied to statements will have any practical value. It is not
anyone's business, in particular, to stop such statements, and the door
will be just as wide open as ever.
If this society wants to accomplish something let it change the word-
ing to something like the following: "Any member making any refer-
ence to his own personal skill, to special methods, etc., or advertising ser-
vice at lower fees than he expects to receive for a fair grade of service, shall
be brought before such and such a conmiittee and if the charge is sustained
shall be suspended for 90 days and for a third offense, suspended per-
manently."
In other words what is needed is not publicity for the dentist's special
qualifications, but for dentistry as a means of good service. — Editor.
Editor Dental Digest:
Will you kindly allow me to answer **A Request for Advice" by
** Massachusetts'' in February Digest. His whole list of questions sum-
marized, is that he believes in honorable publicity, and wants to know
why he can't use it, and retain the respect of other dentists.
During my 32 years as a dentist and reader of dental journals, this
same proposition has been presented in various forms, and nothing
practical has ever come of it.
It is certainly time for a clear answer to be given, so that every den-
tist may understand.
The Code of Ethics, Art. 2, Sec. 2, says: "It is unprofessional to
resort to public advertisements," etc.
There is your answer, and that certainly has been approved by every
dental society in this country by the adoption of their code of ethics.
Moreover, it will never be changed by societies who have adopted it, for
good and sufficient reasons of their own, and any discussion with that
end in view is as useless now as it has been in the past. You may think
this an unreasonable assertion, but let us look at the facts. Let us look
at dental organization as it exists to-day.
Most all of the State Dental Societies belong to the National organi-
ation, and aU have practicaUy the same code of ethics. We will look
into the organization of one state dental society knowing that it is but
similar to all the other states; the knowledge of one will be knowledge for
all.
I have before me the by-laws of the Wisconsin State Dental Society.
This society is incorporated, and its executive council ''has absolute
control of the entire business*' of the society, and may sit with closed
Digitized by V:iOOQIC
236 THE DENTAL DIGEST
doors. This council consists of twelve active members, of whom the
president, secretary and treasurer of the society shall constitute a part
and these shall be the officers of the council. Three members of the coun-
cil are elected each year and serve for there years. The president pre-
sides at all meetings of the coimcil and can call special meetings at the
written request of three of its members. Seven members constitute a
quorum and the majority rules. A majority of the Executive Coimcil
of twelve members is seven, a majority of a quorum of seven members is
four. Thus from four to seven members of the council constitute the
determining power concerning absolutely all the business of the society.
As to the powers of the Executive Council I wiQ quote by-law Art. 2,
Sec. I.
**The Executive Council shall have absolute control of the entire
business of the society and may sit with closed doors. Any member of
the Society desiring to bring any matter of business before the council
may do so in writing and appear in behalf of such measure, by consent
of the Executive Council.''
The Executive Council is further empowered to elect all standing
committees, which are, Dental Science and Literature, Dental Art and
Invention, Publication Committee, Program Committee, Clinic Com-
mittee, Board of Censors, Infraction of Code of Ethics, Local Committee
of Arrangements; also select the place of annual meeting. In case of the
absence of the president and vice-presidents, the council shall fill their
places. The council shall pass on the expenditure of all moneys of the
society. It may authorize certain officers or committees to expend
money for specific purposes. They shall appoint annuaUy an auditing
committee from their own number to examine the books of the secretary
and treasurer.
While there are still other powers granted the council, the above is
sufficient to show that the membership has empowered the council with
absolute authority in all matters of business that concerns the society.
The ordinary member may vote once a year for the society's officers.
May be appointed by the Council on some conmiittee.
May attend the annual meeting.
Shall pay dues. This is the extent of his society organization privilege
and usefulness. So here is the present plan of Dental Society organiza-
tion. What do you think of it?
Now if the code of ethics is to be changed by dental societies as now
organized, by granting and defining honorable advertising from the
twelve dentists governing the state society, what are the prospects? It
has been a long road to their present position and they are satisfied. The
proposed change would endanger the present line-up of prestige and
Digitized by
Google
ANSWER TO A REQUEST FOR ADVICE 237
personally it could not appeal to them. Every society member has
signed the Constitution and By-laws, as well as the Code of Ethics, and
no council dentist could champion such change without censure and loss
of prestige among his fellows. Unquestionably the road is closed for
recognition of honorable advertising by the self-styled ethical societies.
The power of the executive council is supreme. The twelve dentists
direct all things professional in the state. They say the dental profession
will not endorse this or that — they know — ^because they are the profession
— at least the controUing force invested with authorized power.
Those who believe in honorable publicity in dentistry should remember
that it is utterly useless to expect dental societies, as now organized, to
recognize it, and there remains just one thing to do, and that is to organize
dental societies in all the states that do recognize honorable pubUcity in
dentistry, not only as professional, but ethical and reputable as well.
Until this is done, any dentist who uses honorable pubUcity of any
kind, will be looked upon by the profession as improfessional, unethical
and disreputable, the same as they have been during the past 50 years.
Dentists in Wisconsin last year organized and incorporated the
Modem Ethical Dental Society of Wisconsin. They adopted the same
code of ethics as that of the other society, except in regard to that pertain-
ing to advertising; and instead have adopted the following as Sec. 2:
**It shall be unprofessional for any dentist to circulate or advertise
fraudulent or misleading statements as to the skiU of the operator, the
quality of materials, drugs or medicines used or methods practised."
You will see from this that this Society regards all other publicity as
proper.
A similar society has been organized in Michigan and Indiana and
dentists in several other states are now considering such an organization.
We would suggest to all those who believe in honorable pubUcity to find
other dentists in their state who hold the same views, and then organize
a Modem Ethical Dental Society in their state. They then wiU be in a
position, unhampered by a tyrannical code, to conduct their dental busi-
ness in accordance with the dictates of their own conscience.
I wiU be glad to help in any way I can to encourage such organizations
for it is our hope that the time is not far distant when there may be or-
ganized a National Modem Ethical Dental Society. B. A. J.
The weak worry so much about the future than they never get a
foothold in the present. One cannot do efficient work if his mind is
filled with fear pictures of what may happen a year or two years from
now. A mind filled with mental images is asleep to present opportu-
nities.— ^Wm. E. Towne, in The Healthy Home,
Digitized by
Google
238 THE DENTAL DIGEST
HOW TO MAKE A DENTIST HAPPY
Feb. 26, 1916.
Editor Dental Digest: —
I am enclosing a short article which was placed in our local pap)er
some time ago and you are welcome to use it if it is worth the
space. It certainly has had a fine reaction here without getting
any one peeved. I wish to congratulate you on the good stuflf we
get in the Dental Digest.
Yours truly,
W. H. OnM.
There are a nimiber of ways to make a dentist happy but the following
procedure will always appeal to his humor and bring back to him, with
vividness and rejoicing, that moment when he received the inspiration to
study dentistry.
As a prospective patient put off your dental work just as long as you
can so that the teeth will be badly broken down and filthy. They will
then be harder to fill or crown, more painful and in general less satisfac-
tory. Next find out if he guarantees his work for twenty years or fifty
years. A reputable physician doesn't do this but a dentist ought to.
Be sure to insist on getting the best work, which takes most time and
best material, for the lowest cost. You can't buy a $20 suit for $10 in a
clothing store or a Cadillac for the price of a Ford, but of course in den-
tistry it is different.
Upon seating yourself in the dental chair, inform the dentist how
nervous and fussy you are, how brave you used to be and that you don't
mind anything but the drilling. As soon as you feel the slightest indica-
tion of pain grab his hand and make him apologize. About this time
get pale around the gills and pretend to faint; this will cause a delay and
you can tell your friends how much time you have to spend in the dental
office. Don't let hitn drill very thoroughly because this hurts and insures
better work. Do not attempt to keep your second appointment, after the
teeth have been temporarily treated and ache stopped. The dentist's
time isn't worth much and he won't care, especially if he had to deny
someone else the opportunity of coming because of your appointment.
When the work is finished don't pay for it because he doesn't need
money. He gets his gold and materials as premiums especially since the
European war. Tell him you will pay when you can spare it. From
then on do not go near the office for at least a year or two and avoid
him as much as possible. After he has sent you several statements and
threatens to employ an attorney, call or send someone to settle the ac-
Digitized by
Google
THE BUSINESS SIDE OF DENTISTRY 239
count. Be sure to tell him that the work was very unsatisfactory and
has been aching day and night ever since it was completed and that you
expected to have someone else do it over again. This will make the
dentist regret that he was so rude in trying to get his money. If you
make this part of the story strong enough he probably will cancel the debt
entirely and pay you in addition for your inconvenience and humiliation.
W. H. Ohm, D.D.S.
THE BUSINESS SIDE OF DENTISTRY*
By J. J. Simmons, D.D.S. , Dallas, Texas.
The boomerang will come around and strike your own head in time.
In this connection I would add, that he who is wise in his own conceit
becomes a liar as sure as the night follows day. True wisdom is as modest
as a virgin, as timid as a fawn, and as generous as the light of the sun.
It knows no selfishness, and he who possesses it doesn't lie.
Charity should be exercised in our labors. The Lord said the poor ye
have with you always. Twenty-five per cent, of mankind works and
takes care of the other 75 per cent., hence you should do your share.
With reference to fees, I would say that, as a whole, the dentist earns
what he gets, yet he alone is responsible for the .existing conditions if he
does not receive enough for his services.
A capital plan to raise prices is to spend spare time in self-improvement
not only as regards the profession, but along all avenues of Ufe. Reading
enables one to keep in touch with the happenings of the day and develops
as well a pleasing personality, and one's personality is one of the greatest
assets in securing and retaining a clientele to be desired.
Regular exercise and vacations tbne up the system and strengthen
one morally, mentally and physically. Correct habits enable the dentist
to render better service to his patients and attract the better class.
Breadth of thought toward your professional brethren makes the
business of dentistry more genteel to us, to them, and beyond doubt it
raises us in the estimation of the laity.
CLOSING REMARKS (dR. SIMMONS)
One of the things that seems to be rather uppermost in the minds of
all of you is, '* How to get the money "? Now I don't have much thought
of money. I have fixed a rule for myself, and if you will permit a little
personal reference — I work while I work and play while I play. One of
*Abstract from paper presented at January meeting of the Dallas County Dental Society.
Digitized by
Google
240 THE DENTAL DIGEST
the best tributes my mother ever paid me was when she said that she had
never heard me discuss my business. Leave your business at your office;
don't take it home and go to bed with it; it won't help at all. Leave your
business at the office.
When you go into a department store, did you ever notice how the
young lady who waits on you always says, "Cash or charge"? Now
have your business fixed so that you will be able to make money out of it.
If you haven't the nerve to ask your customers for the money, you ought
to hire somebody to do it for you. Now I have a little red-headed stenog-
rapher in my office who has one fixed idea in her mind, and that is "get
the money," and if you should walk into my office and ask to see me
about professional services she would walk right up to you and say, "Do
you want to make a deposit"? She never lets them get by, I don't care
who it is.
In our desire to accomplish things in this life brings to mind a little
story which I remember and which may be worth something to you.
There was once a dog named Jack who lived in a neighborhood where
there were a lot of dogs just a Uttle bit bigger than he was and every time
he got away from home these dogs would tear out after him and he would
tear out home. He just couldn't stand the pressure; it was too much for
him. His master decided to go away and started on his journey. So
Jack thought he would like to go and started out following just behind,
and every now and then some dogs would run out and almost eat him up
and then leave him, and he would have to run and catch up with the wa-
gon again. One day while they were on the journey and Jack was running
alongside he dropped into a bear trap and before he knew he had hit the
bottom. He looked all around and then he saw the bear.. He knew he
was cornered and so he said to himself: "Now, Jack, you have been a little
coward all of your life; you've never had any nerve; right here's where you
will have to fight for your Ufe — you are going to mix up with this bear;"
and so when he had said this to himself he felt better and he started in
and for once in his life Jack made a fair fight and came out victor. He
was so pleased with himself that he started in from that time on and he
whipped every big dog he came across and he made up his mind that
when he got back home he was going to whip that old crowd. He had
found his place — he had become a victor by having adjusted himself
after having found his place, and Jack died a beloved and brave dog.
It is just as easy for every dentist in the city of Dallas to make a
good business man, if we will just assert ourselves and use our talents,
use good judgment.
Get up every morning with one word in your mind, "Deposit," and if
you will do that you will get the money. — The Texas Denial Journal,
Digitized by
Google
THIS PATIENT FRANKLY LEAVES THE REWARD TO GOD 241
THE DENTIST'S OFFICE HOURS
The following table received from Fawcett & Fawcett, Brooklyn,
shows that all of this agitation about the number of office hours, number
of income hours, overhead expense, remuneration, average fees and that
sort of thing, is entirely unnecessary.
Do you see the catch?
365 Days in the year — 24 hours each.
122 Sleep 8 hours.
243
122 Pleasure 8 hours.
121
52 Sundays.
69
26 Saturdays J days.
43
14 Vacation.
29
13 Legal Holidays.
16
15 Lunch.
I O Yom Kipur.
Hence you do no work at all in the 365 days from actual accounting.
THIS PATIENT FRANKLY LEAVES THE REWARD TO GOD*
It isn't often that a patient speaks his mind right out in this way, but
many of them practise the belief that God is the one to reward the den-
tist.
This letter was received by a prominent dentist in India. — Editor.
Drs. Smith Bros.
American Dentists
Sir:—
I have been suffering from tooth disease for a very long time, I will
give below the present state of my teeth and humbly request you to
•Courtesy of Dr. W. P. Heaney.
Digitized by V:iOOQIC
242 THE DENTAL DIGEST
kindly give me free advise for which God will reward you. I have used
all sorts of medicines but failed. Blood always comes out from the roots
of my teeth. If the gums are pressed with finger ends a kind of matter
pus comes the smell of which is bad, consequently very bad smell comes
out always from my mouth, but do not feel any pain, of course they
shake a little. My age is 30. The material like cement which is at-
tached to the gums have all gone. My digestive power is very weak and
irregular. I think the reason of it are that food which I eat are mixed
with blood when chewing to get into the belly, thus causing indigestion.
Also when laughing and feel a slight hurt into my face, blood comes out
which smells bad.
I beg you kindly send a prescription for which act of kindness I will
ever remain ever gratefully yours.
I remain yours
Editor Dental Digest: —
On page 815, December 191 5 Digest is an article taken from Deutsche
Medizinische Wochenschrijt^ August 19, and called '* Fatal Case of Pyor-
rhea Alveolaris."
The history of that case, as it reads, is very near like one in my own
practice in the winter of 191 3. Man about thirty-five years of age.
The trouble looked like a very severe case of pyorrhea. I first extracted
upper left ist bicuspid, then in about two weeks the second bicuspid.
They would not heal up. Very foul breath. I soon found out it was
something I had never met with before, so I took him to a M.D. He
was as puzzled as I was, and the patient finally lost all the teeth on left
side clear up to and including the right central. The gums would not
yield to treatment, and continued to discharge. In the meantime,
the patient had fever, lost over fifty pounds in weight, when all of a
sudden (forty-eight hours), he developed very severe ulcers of throat.
He came in to see the M. D. and he called me and when I went in he
said: '*Dr. J. , I have found the trouble. This man has syphilis."
(This was about three months after I first saw the patient.) He pro-
ceeded to treat for same and was pleased to soon see improvement. The
gums soon healed up and this winter I made the patient a partial denture,
and he seems to be all right (to outward appearances) again. He claims
never to have had any venereal disease.
E. G. J.
Digitized by V:iOOQIC
AN ANSWER TO A QUERY 243
THE EFFICIENCY OF THE "TRUBYTE TEETH"
By George W. Weld, D.D.S., M.D., New York City
I am prompted to relate the history of one case of a full upper and
lower denture which would seem to emphasize the importance and ne-
cessity in certain cases, at least, of making use of the **Trubyte" teeth in
conjunction with the Gysi Adaptable Articulator. Mr. U. R. called upon
me March 5th, 1915, for consultation. He informed me that during the
past five years he had seven sets of teeth made by as many different den-
tists and that he was almost discouraged of ever finding a dentist who
could make him a set that he could wear with comfort and usefulness.
On examination, I found one of the most difficult cases that had ever
come under my observation.
In company with my patient, I called upon Dr. James P. Ruyl for
consultation and help. Proper measurements were taken and the appro-
priate teeth selected. The teeth were articulated and ground up a la
Gysi, and inserted in the mouth.
I am now able to report that the gentleman was enthusiastic over the
result saying "I am convinced as you told me, in the beginning, that
the Trubyte Teeth and the Gysi articulators have proved indispensable
in my case, for proper comfort, and efficient mastication purposes."
AN ANSWER TO A QUERY
What metal is best for castings, to be used under gold crowns, for
the purpose of building up badly decayed roots to support crowns?
Would there be danger in using coin silver, containing 10 per cent, copper,
in case the crown failed and exposed the coin silver to the secretions of
the mouth?
In answer to above (page 115, February issue of Dental Digest) —
would suggest using Westoria New Metal, in preference to coin silver or
an alloy of silver as this will not corrode when exposed to saliva and also is
much cheaper than silver. We very frequently cast practically a whole
tooth out of it, and I have never seen a case where it corroded. — B. C.
Taylor, North Wilkesboro, N. C.
One of our correspondents handed us the following which we con-
sider worth time for reflection: "Income is the result and measure of
ideas and effort. '* It looks logical if you consider the business side of
dentistry as a part of the aforesaid ideas. — Nebraska Dental Journal.
Digitized by
Google
siGTicM. Urns
[This department is in charge of Dr.
V. C. Smedley, 604 California Bldg.,
Denver, Colo. To avoid unnecessary de-
lay, Hints, Questions, and Answers should
be sent direct to him.]*
Securing Brightness in Aluminum-Rubber Plates.— The hydro-
gen sulfid liberated in vulcanizing has a tendency to darken the aluminum
in alimiiniun-rubber plates. To avoid this, the aluminum base-plate is
covered with shellac or sandarac. — Zahnaenztliche Rundschau {The
Dental Cosmos.)
A Useful Application for Sore Lips While Operating . — A little
collodion is very useful to apply to sore lips before beginning to operate.
It takes out the soreness, protects the lips, and they heal rapidly after
the application. It is also useful to wounds on the hands, reducing the
danger of infection and washing will not remove it. — Pacific Dental
Gazette,
Repairing Punctures in Rubber Dam After Adjusting. — ^Take a
piece of surgeon's adhesive plaster of the proper size, slightly warm it
and cover the punctures. It will effectually seal the opening. — Pacific
Dental Gazette.
A Loose Pin Banded Crown Especially Adapted for Upper
Lateral Incisors. — Prepare the root the same as for a Richmond, being
certain that you have the enamel removed and not beveled. Fit band
and trim to contour or outline of gum. Then remove band, place on end
of block of soft wood and place crown in band and swage slightly. The
crown should be a trifle larger than the band and ground to a very slight
bevel before swaging; then place band on root again, after having ground
crown to fit root, and swage again directly against the root. Then re-
move and if you wish gold partition between crown and root, cut disk to
fit about to the centre of the band vertically; again replace band and press
disk up against root. Take impression, remove, invest and solder disk
into band, using as little solder as possible. Then remove and drill hole
large enough to receive pin, but not the collar; replace band on root, press
pin in up to collar and with sharp pointed instrument outline collar, re-
move and cut to outline. You are now ready to polish and cement.
♦In order to make this department as live, entertaining, and helpful as possible, ques-
tions and answers, as well as hints of a practical nature, are solicited.
Digitized by
Google
PRACTICAL HINTS 245
Having root dried, fill hole in crown with cement and place pin part way,
then put some cement on both sides of centre disk in band; then fill hole
in root and put on the crown and you have a crown as serviceable as any,
and in case of repair, easily and quickly done. — B. A. Wright, D.D.S.,
Latrobe, Pa, The Dental Summary,
To Repair Gold Crowns. — ^To repair crack or hole in gold crown,
burnish over same piece 22 or 24 karat gold sufficiently large to cover
space; flow upon same 14 or 18 karat gold solder, place it upon crack or
hole with soldered portion in contact with latter, hold together with pliers,
heat gently, and patch will adhere readily to crown. — J. A. Richards,
D.D.S., BfoomeWs ''Practical Dentistry r
A Gasolene Soldering Outfit. — Necessity is the mother of this
little discovery, which may be of some benefit to other practitioners. If
no gas supply is available for soldering, one has to depend on one of the
various gasolene outfits for the laboratory. Anyone who has stood on
one foot over a hot blowpipe on a hot summer day, pumping bellows with
the other, can appreciate the relief this arrangement will -afford.
A Red Devil water motor, costing $3; a Vernon rotary compressor,
costing $7.50, and a Buffalo gasolene gas tank and blowpipe are secured.
The pulley wheel is removed from the Vernon compressor, and a sleeve
connection made connecting the axle of the compressor and the water
motor, thereby obtaining a direct shaft drive. The compressor and the
gasolene tank are then connected with tubing of the desired length. Then
the water is turned on the motor, and with the correct quantity of gasolene
at the proper temperature in the tank, soldering can be done with the
same comfort as with a gas outfit. I am using this arrangement every
day, and find it to work perfectly. — C. G. Baker, Act. Dent. Surg., U. S.
Army, The Dental Cosmos.
How TO Remove Broken Instruments. — For difficulties of removing
the fragment of an instnunent from a root canal, — especially if it has
become embedded in the apical third, — and the inadequacy of the gen-
erally advised means for removal, I would recommend section of the root,
guided by the aim of saving as much tooth structure as possible. My
method of operation consists in turning over a flap of mucous membrane
under local anesthesia, and making a windowlike opening in the alveolus
with the aid of a fine, sharp chisel; the location of this opening to be de-
termined by the x-ray picture. The root thus exposed is opened in its
long axis with a fine rosehead bur, the embedded instrument is quickly
exposed to view, and pushed out in the direction of the pulp chamber with
stout, curved sounds. In order to avoid an oversight or swallowing of the
broken instrument, a pellet of cotton has been previously introduced into
Digitized by
Google
246 THE DENTAL DIGEST
the pulp chamber in order to engage the fragment upon removal. The
incision in the root is then fi^ed with tin, gold or amalgam, the limien of
the canal being preserved by a sound previously introduced into the canal.
If the canal has been opened up to the apical foramen, this sound is super-
fluous, as an hermetic sealing of the canal is desirable. The field of opera-
tion is carefully cleansed and sterilized, and the wound in the mucous
membrane closed by a suture. This operation is, of course, most favor-
ably indicated in single-rooted teeth. It has the advantage over resection
of the root apex, as recommended by Williger (see Dental Cosmos, No-
vember, 191 2, p. 1289), that the amount of injury inflicted upon the
tooth is very small, a slit of i mm. breadth being sufficient, and that a
very small portion only of alveolar bone need be removed, since the
broken instrument is removed by way of the pulp chamber. — E. Schus-
ter, Leipsig, Deutsche Monatssckrift fuer Zaknheilkunde. {American
Denial Journal.)
Hypodermic Syringes. — If your all-metal hypodermic syringe
'* leaks back," take out the leather washer and replace with a strand or
two of asbestos *'rope." This answers the purpose better than leather,
and will stand boiling without materially affecting same. — J. Fred
Gordon, Albury, N. S. W., Commonwealth Dental Review.
QUESTIONS AND ANSWERS
Question. — Will you or some of your readers tell me if the glass or
formaldehyde sterilizer for dental instruments is efficient and thorough?
I saw much advertising for different makes of that kind of sterilizer
several years ago, but in the last year or so I haven't seen any, or any
writing at all, about them.
Also would like to know of a practical way of sterilizing handpieces.
— H. E. S.
Answer. — The formaldehyde sterilizer (preferably the glass one) is in
quite general use, I understand, to keep instruments in weak solution
after they have been sterilized by boiling. The solution strong enough
for sterilization has quite a disagreeable odor. I know of one case where
a dentist used it for sterilization for a year or two, dipping his hands into
the liquid daily until his hands became sore and remained so for a number
of weeks— formaldehyde poisoning he thought.
I believe the most practical way to sterilize handpieces is to immerse
them in 60 per cent, alcohol. Let them run in same for a minute between
patients and then let them soak in it over night. Wipe off and oil before
using, as alcohol kills the lubricant. — V. C. S.
Digitized by
Google
Wf
PROPOSED STATEMENT OF AIMS
n n n ml ahd objects-
FEDERATION OF MEDICAL ECONOMIC LEAGUES
This statement, taken from The Medical Economist's Official Organ
of the Federation of Medical Economic Leagues, contains some sugges-
tions of more than passing interest to dentists, and especially the refer-
ence to administration of anaesthetics. The whole thing is worth your
perusal as it shows a movement in medical circles which looks like ''busi-
ness."— Editor.
The Federation of Medical Economic Leagues has for its objects the
protection and promotion of the economic and professional interests of all
medical men, the increase of the usefulness of the medical body to the
community, and the conservation of the public welfare. Holding that
these objects are not opposed, but, on the contrary, are intimately con-
nected with one another; that the public is best served when the economic
and social status of the medical profession is conmiensurate with the im-
portance of its communal duties; and that the important changes which
have taken place and are still taking place in our social organization re-
quire a careful readjustment of medical practice to accord with the needs
of the times: — the Federation declares its aims to be the following:
I. To organize the profession on a democratic basis, creating a
medical body politic that shall include all legal practitioners of medicine;
to the end that both its external and its internal adjustments may be
developed as the true interests of the public and the profession require.
n. To study the economics of medical practice in its modern develop-
ments, and the means of adapting its present conditions to changing social
requirements.
III. To publicly represent the medical profession, and to inform the
community of its legitimate needs and aspirations; we holding that want
of general information is the occasion of much present maladjustment.
IV. To promote and foster in our own ranks that spirit of justness
and fairness in our mutual and civic relations that will render formal
codes of ethics unnecessary.
V. To secure for the practitioner proper recognition and just com-
pensation for his work; and to equalize the burdens of communal charity,
which the present system inequitably disposes to our disadvantage.
♦Submitted by the special Conmiittee, Feb. i, 191 6.
Digitized by V:iOOQIC
248 THB DENTAL DIGEST
VI. To oppose any curtailment of the necessary rights and privileges
accorded to physicians who conform to legal requirements.
VII. To cooperate whenever possible with dvic and private bodies
whose endeavors bear relationship to the public health or to medical
practice; to favor the enactment and enforcement of just and uniform
medical laws; and to oppose medical legislation that is detrimental to the
public interest, or improperly encroaches on medical practice.
VIII. To« raise the standard of medical education of licensed practi-
tioners as well as of undergraduates; to which end the opportunities for
observation and study that are afforded by public institutions should be
open to the profession at large, and not be monopolized by a few individ-
uals.
The more^immediate objects of the Federation of Medical Economic
Leagues in New York are :
1. To discourage and gradually to abolish the present system of volun-
teer medical work in our public and private medical institutions, which is
inefficient and unjust to the workers; and to substitute therefore a system
which shall place the community work done by the medical profession on
the same plane as that done by other members of the body politic. We
hold that medical services in hospitals, dispensaries, and similar institu-
tions should be paid for, as all other services are paid for.
2. To uphold and support the health authorities in all their legitimate
activities in sanitation and disease prophylaxis, but to oppose their en-
trance into the field of disease treatment. The public charities depart-
ment can and should take care of the indigent sick; and we regard the
establishment of public clinics by the Health Department for the treat-
ment of special diseases as an unnecessary expense which pauperizes the
community and injures the medical profession.
3. To oppose the indiscriminate administration of medical charity
by public and semi-public institutions; to enforce the principle that,
when supplied without honest investigation and on the same basis as any
other poor relief, it is detrimental to the entire conununity; and to secure
the enactment and enforcement of efficient regulations for this purpose
in the place of the present ineffective law.
4. To oppose all projected laws or amendments of laws that would
permit individuals not possessed of the prerequisite educational require-
ments, and not examined and licensed by the State as practitioners of
medicine, to practice medicine in any form or under any subterfuge, or
to assume any of the duties or responsibilities of physicians.
5. To safeguard the rights and promote the equitable interests of
medical men under the various enacted and projected schemes of State
Digitized by
Google
ADVICE TO THOSE ABOUT TO WEAR ARTIFICIAL TEETH 249
Industrial and State Health Insurance; and to prevent the individual
exploitation of medical practitioners in them by corporate interests.
6. To gradually extend to all licensed physicians, under proper safe-
guards, the facilities for caring for their patients in, and the opportunities
for study and improvement afforded by, the public medical institutions
of the dty and state; we holding that a license by the state to practice
medicine in the commimity at large necessarily connotes the ability to
care for its individual members when they have become public charges.
ADVICE TO THOSE ABOUT TO WEAR ARTIFICIAL TEETH
By D. W. Barker, M. D. S., Brooklyn, N. Y.
The advice here given has been a help to others and may be a help
to you. You are now about to begin to learn to do something you have
never done before — to use an artificial substitute for natural organs
(teeth) and, however perfect they may be, they are not equal to the
natural teeth, nor are they used in the same way.
Do not expect to acquire facility in the use of these new things at once.
That comes only by practice, patience and time. You cannot learn it in
a few days, or a few weeks. You will learn it a little at a time, day by day,
gradually acquiring conunand over them. In a month or two you should
acquire a considerable degree of skiU. Above all, do not become dis-
couraged and get the notion that your experience is in any way different
from that of other beginners. All others who wear artificial teeth have
to go through this process of self education. The dentist may do his
part perfectly, but this is something that you have to do for yourself;
no one can do it for you, and unless you do it your teeth will not be a
success. You should not allow yourself to get into the habit of leaving
the teeth out. To do so is to incur a distinct loss, for no one ever learned
to use a set of teeth by wearing them in the pocket or the bureau drawer.
You can learn to use them only by using them, just as a child learns to
walk by walking, though imperfectly at first.
There are two things that will take you longer to learn than anything
eke, namely, talking and eating. I will consider them separately. In
speaking there are certain sounds that are apt to be more difficult than
others; s, x, ch and sh are the worst. A good way to overcome this diffi-
culty is to practise reading aloud. Do it alone so there will be none to
attract your attention. Read slowly and make it a point to enunciate
each syllable distinctly. When you meet with a word that bothers you,
stop and say it over and over until you can say it distinctly. Remember
Digitized by
Google
250 THE DENTAL DIGEST
you are training the muscles to obey the will very much as a child does
in learning to talk. The more this simple and easy exercise is practised
the quicker you will be able to speak distinctly. Following this plan
most of the difficulties of speech will disappear in a few days.
Learning to eat with them will take you somewhat longer, but the
principle is the same. Don't expect to eat your first meal with your new
teeth just as you did with your natural teeth, nor just as someone else
does who has worn artificial teeth for many years, for you won't do it; no
one ever does it. I used to know a dentist who would tell his patients
not to yield to the temptation to take out their teeth at their first meal
and they would not want to take them out the second time. This I
consider bad advice, because the patient is apt to become discouraged at
his failures, and get the idea that there is something wrong with the teeth
or himself. If you become discouraged and lose confidence in your
ability, the teeth will not be the success that they should be. Therefore,
I would not advise a beginner to try to do too much at first. If you only
eat part of the first meal with them you are doing very well. Gradually
increase the length of time at each meal, eating slowly, and in a few days
with increased confidence and control, which comes by practice, the whole
meal can be essayed. Even then you will find you are learning something
more every day and as the days pass an increased efficiency is acquired.
If you attempt to bite upon a hard substance, like an apple or an ear
of com, you will probably trip them, for this is a severe strain upon the
suction. It may be accomplished, however, by pressing the apple firmly
upward against the teeth at the moment of biting upon it. This may be
tested with the finger, and it will be found quite impossible to trip them.
Some people acquire a habit (after their teeth have been extracted)
of holding a handkerchief over the mouth when in the act of laughing.
If you have such a habit you should break yourself of it at once, for the
action directs the attention of the observer to the mouth; if you do not
make the motion no one will think of looking there.
"Shall I keep them in at night?'' is a question often asked by a be-
ginner. To this I answer, ** Xo, not right away, because they would keep
you awake. But after you have become accustomed to them you may
try it if you think you would be more comfortable. It is just as you
find it most comfortable. "
If you find that your plate makes a sore spot, usually somewhere
along the edge, this is not an indication that the plate does not fit prop-
erly, but merely that there is a little too much pressure at that particular
spot which should be relieved by filing off a little. Almost all new plates
have to be relieved in this way. Return to the dentist while the place
is sore (not after it has gotten well) and he will know how much to file it off.
Digitized by
Google
AN EPITOMB OF CURRENT DSNTAL AND MEDICAL LITERATURE 251
Your artificial teeth should be kept dean. To do this they should
be carefully and thoroughly scrubbed with a stiff brush several times a
day (after each meal if practicable). A tooth brush is not a good brush
for this purpose. A small hand scrub brush is much better.
In conclusion, I wish to urge you to give no heed to the teasing or
joking comments of your friends. In most cases it has no serious mean-
ing, but may arouse dissatisfaction in your mind where no cause for dis-
satisfaction really exists. — The Dental Summary.
AN EPITOME OF CURRENT DENTAL AND MEDICAL LITERATURE
[The Denial Cosmos, March, 191 6]
Original Communications
War Dental Surgery: Some Cases of Maxillo-facial Injuries Treated in the Dental Section
of the American Ambulance at Neuilly (Paris), France. By Dr. 'Geo. B. Hayes.
•The Innervation of Dentin. By J. Howard Mummery, D.Sc., M.R.C.S., L.D.S.
The Porcelain Inlay in Europe. By N. S. Jenkins, D.D.S.
The Evolution of the Human Face and Its Relation to Head Form. By Dr. E. A. Hooton.
The Design and Retention of Partial Dentures. (I). By Douglas Gabell, M.R.C.S., L.R.C.P.
L.D.S.
Sanitary Dental Cuspidors on Board Ships. By J. D. Halleck, B.S., D.D.S.
The Importance of Biology as Applied to Dentistry. (II). By Dr. Ch. F. L. Nord.
Precautions to be Observed in the Care of Mouth Infections with Regard to the Preservation
of Health. By W. Stirling Hewitt, D.D.S.
Methods of Teaching Orthodontics to Dental Students. By S. H. Guilford, A.M., D.D.S.,
Ph.D.
Public Dental Services. By Walter Harrison, L.D.S., D.M.D.
The Germicidal Efficiency of Dental Cements. By Paul Poetschke.
Prophylactic Treatment at Different Ages. By Prof. Albin Lenhardtson.
THE INNERVATION OF DENTIN
By J. Howard Mummery, D.S.C, M.R.C.S., L.D.S.
POINTS DEMONSTRATED BY THE WRITER'S PREPARATIONS
(i) That, at all events in actively growing teeth, there is a considera-
ble supply of non-meduUated or efferent fibers to the tooth pulp, which
are derived from sympathetic ganglia and not concerned in any way with
the sensitiveness of the dentin, their ultimate fibrils probably being dis-
tributed to the coats of the bloodvessels and the secreting cells of the
pulp; whether any fibers of this system enter the dentinal tubes it seems
impossible to determine.
(2) That at the comua of the tooth pulp, the bundles of medullated
nerve fibers lose their medullary sheath and neurolemma, and the axis
Digitized by
Google
252 THB DBIITAL DIGEST
cylinder expands into a spreading mass of neurofibrils, which can be
traced directly to the dentinal tubes, which they enter.
(3) That in young, growing teeth, these fibers at the comua are very
abundant, and have a wavy course; they appear to consist of bundles of
neurofibrils in many instances, and these vary much in diameter, the
further divisions of these bxmdles probably taking place in the tubes of
the dentin.
(4) That at the lateral portions of the pulp, the neurofibrils passing
from the main nerve trunks enter into an intricate plexus beneath the
odontoblasts, and are again collected into larger strands of neurofibrils,
which mostly pass directly into the dentinal tubes. They also demon-
strate the different appearances of these strands of fibrils, some being
large and showing bead-like enlargements at intervals, other finer fibers
having a minutely dotted appearance.
(5) That where the pulp is separated from the dentin, the nerve fibers
seem to be pulled out from the pulp and from the dentinal tubes, and
stretch across the interval, evidently under considerable tension.
(6) That .the nerve fibers enter the dentinal tubes in company with
the dentinal fibril.
THE IMPORTANCE OF BIOLOGY AS APPLIED TO DENTISTRY
By Dr. Ch. F. L. Nord, Gorincheh, Holland
CONCLUSIONS
In closing, I wish to draw the following conclusions:
(i) The decline of the teeth must especially be ascribed to panmixia,
and cannot be considered as a symptom of degeneration according to the
present stage of biological science.
(2) The connection between anomalies of the teeth and other deformi-
ties (hair and eye diseases, deft plate, etc.) is probably caused by the
inferior quality of a certain hereditary variant, which is the cause of all
these anomalies.
(3) Anomalies of the teeth, so far as they are not brought about by
apparent external causes, must be considered as hereditary, and it is there-
fore of great importance to make a careful researjch into the facial relations
of the family of the patient before beginning treatment.
(4) Whereas dental anomalies of all possible grades may be inherited,
and whereas it is very probable that there is a correlation disturbance in
the relationship of the upper to the lower jaw which may involve aU di-
mensions, we must, in the treatment of those anomalies, resort to extrac-
tion, and we must also consider as biologically incorrect the standpoint
of Angle's school, viz., that in the restoration of normal occlusion and
normal facial relation's, extraction is at all times unnecessary.
Digitized by V:iOOQIC
AN EPITOMB OF CURRENT DENTAL AND MEDICAL LITERATURE 253
PUBLIC DENTAL SERVICE
By Walter Harrison, L.D.S., Eng., D.M.D. Harv., Brighton, Eng.
The movement of public dental service must be national, in the sense
that those who are eligible for treatment, even in remote villages, should
be able to avail themselves of the privileges.
The fundamental principles in a public dental service should be:
1. The service should be entirely controlled by the profession.
2. Every reputable registered dentist in the district should have the
option of joining the staff.
3. The profession (by means of a committee) should decide who are
suitable persons to receive the benefit. •
4. The fees should be fixed by the local practitioners.
THE FIRST ''public DENTAL SERVICE."
The "Brighton and District Public Dental Service" is formed to
check "the admitted evils of excessive medical charity and misuse of
hospitals," and enable certain sections of the community, who are unable
to pay the ordinary fees, to obtain dental attention by registered dentists,
at modified fees, and by a system of payment by instalments, through
the means of an organization under the control of the local members of
the profession.
[The Dental Review, March, 1916]
Original Communications
What IS the Matter with Dentistry in St. Louis? By Clarence O. Simpson.
President's Address. By E. A. Boyce.
Some Recent Tendencies in Practice. By Arthur G. Smith.
Three Years and Some More. By Franklin B. Clemmer.
Chemical Treatment for Pyorrhea Alveolaris-Necrotic Tissue. By J. S. Bridges.
Proceedings of Societies
Chicago Dental Society.
St. Louis Dental Society, October 12, 191 5.
Editorial
Dental Service in the Public Schools of Chicago.
[The Dental Summary, March, 1916I
Regular Contributions
The Place of the Silicates in Dentistry. By Charles C. Voelker.
A One Tooth Bridge. By D. D. Smith.
Root Resection and Apical Canal Filling After Resection. By Carl D. Lucas.
A New Retainer for Pyorrhetic Tooth. By Alden J. Bush.
Some Problems in Mounting Artificial Dentures. By George H. Wilson.
The Anatomy of the Oral Cavity in its Relation to Local Anesthesia. By Hugh W. Mac-
MiUan.
President's Address. By Edward C. Mills.
Digitized by
Google
254 THB DENTAL DIGEST
*Soine of the Cases Dental Surgeons Treat in the European War. By A. M. Fauntkroy.
Historical Sketches and a Few Items m Practice. By J. G. Templeton.
♦The Oral Prophylaxis Treatment vs. "Cleaning Teeth." By Gillette Hayden.
A Sand Sterilizer. By C. S. Starkweather.
SOME OF THE CASES DENTAL SURGEONS TREAT IN THE EUROPEAN WAR*
By Surgeon A. M. Fauntleroy, U. S. N., WashiKgton, D. C.
"One of the most striking features of the value; of a dentist in the or-
ganization of a military hospital is shown in the results obtained by sur-
gical cooperation with the dentists at the American ambulance in con-
nection with the mutilating wounds of the face (Illustrated). These
wounded always show compound fractures of the upper or lower jaw,
with a variable amount of loss of substance. They represent a class of
cases which extends over a period of months before a final operation is
performed which completes the result. A wound of this character is
considerably hampered at first with reference to the healing process on
account of the secretions from the mouth and the necessary feeding of
the patient. At the first operation these ragged and mutilating wounds
are treated by the careful trinmiing away with scissors of the sloughing
areas. In this procedure the vermilion border of the lip is preserved as
much as possible, and then the tissues are loosely brought together with
sutures and protected by a loose dressing, which has to be changed sev-
eral times a day.
The preliminary steps of the operation consist of shaving the face and
neck, scrubbing with green soap and water, followed by 70 per cent,
alcohol. As the mouth secretions are profuse and the bleeding rather
free, it will be necessary to provide means for the prompt removal of this
mixed fluid from the pharynx during the operation in oi*der not only to
prevent strangulation but also the inhalation of septic material which
may cause pneumonia. This is best accomplished by a simple water-
suction apparatus secured to a faucet in the operating room and having a
long tube attached which ends in a good sized catheter. This latter is
held in the pharynx by an assistant during the operation, and the fluid is
thus removed as it accumulates.
The most that is hoped for from the first operation is that the soft
parts will unite in such a way as to admit of correcting any serious de-
formity later on by means of a final plastic operation. There are usually
three stages in the general operative procedure. The first stage consists of
*To give our readers something of an idea of some of the face and jaw wounds that the
army dental surgeon, in the European war, has to treat, we copy this description from the
' * Report on the Medico-Military aspects of the European War," by Surgeon A. M. Fauntleroy,
U. S. N., which has just been published. — Editor.
Digitized by
Google
AN EPITOME OF CURRENT DENTAL AND MEDICAL LITERATURE 255
bringing the soft parts loosely together, as indicated above. Usually
there is so much loss of bony substance that no effort can be made at this
time to unite the fractured ends of the bone.
After the soft parts have united, the second or dental stage is begun.
A metal bridge is anchored, by the dentist, on whatever teeth remain at
the ends of the fragments. This bridge may be temporary at first for the
purpose of simply holding the loose fragments in a steady position in the
mouth. Gradually a scar will form over the ends of these fragments and
the continuity of the mucous membrane of the mouth is slowly restored
over the scar thus formed. The condition of the parts at this time is
fairly satisfactory although there may be considerable puckering as a
result of the partial or complete healing of, the original wound. Once
the mucous membrane has grown over the scar between the bone frag-
ments the third stage of the operation may be attempted. This consists,
first, of a plastic procedure, which is directed toward as complete a res-
toration of the face as is compatible with the destructive effects of the
original wound and the available skin in the immediate neighborhood of
the scars. The second step consists in the removal of a portion of a rib,
or of the tibia, which is then transplanted to complete the bony continuity
of the jaw beneath the bridge.
In proceeding with the plastic op)eration on the skin, it may be neces-
sary to partially remove the scar so as to bring about a better readjustment
of the tissues. Injury to the newly formed mucous membrane must be
carefully avoided, but if it is necessary to incise it, or if accidentally
wounded, it must be carefully sutured. Having outlined the plastic
work by the formation of suitable skin flaps, the ends of the bony frag-
ments are carefully dissected free from the scar tissue so that no injury
results to the underlying mucous membrane. The ends of these frag-
ments are now freshened by either beveling or grooving. An accurate
estimate is then made of the bone required to bridge the gap and a suit-
able piece of rib with periosteum may be resected, or a portion of the tibia
with its periosteum may be removed, according to the preference of the
operator.
There are several ways of securing the transplanted bone in place.
It may be beveled and fitted into corresponding grooves at the ends of the
fragments; it may be drilled and sutured in position with chromic gut; or,
if the conditions are favorable, some form of bony inset may be attempted
along the lines of a mortise and tenon joint. Having fixed the bone in
place, the skin flaps are sutured and boric acid dusted over the suture
lines. The after-treatment consists of careful liquid feeding and frequent
mouth washing.
Digitized by
Google
256 THE DENTAL DIGEST
THE ORAL PROPHYLAXIS TREATMENT VS. "CLEANING TEETH"
By Gillette Hayden, D.D.S., Columbus, Ohio
The advantages of the oral prophylaxis treatment over the usual
process of cleaning teeth are:
First: The treatment given is definitely aimed at the elimination from
the mouth of all d6bris.
Second: The tooth surfaces are rendered smooth so that d6bris will
not adhere so readily to them, and the patient therefore can more accur-
ately care for the mouth and teeth.
Third: The patient is stimulated to give better attention to the
mouth and teeth because of the frequent treatment at the hands of the
dentist.
Fourth: If any cavity development occurs, or any dental operation
becomes faulty, or any adverse condition of the mouth develops, the den-
tist has an opportunity to discover such a condition in its early stages.
Fifth: The teeth and their investing tissues are maintained in such a
state of health that their resistance to disease will be normally high.
Thus to a great degree decay of the teeth and loss of their investing tissues
through disease are prevented, as are also those systemic diseases which
result from mouth infection.
[The Dental Outlook, March, 1916]
Original Communications
The Present Status of Oral Sepsis, Its Relation to Systemic Disease — J. Grossman, M.D.
Discussion of Dr. Grossman's Paper. By M. Grossman, M.D.
A Small Inlay Becomes a Large Outlay. By L. Eliasberg, D.D.S.
On the Admission of Dentists to Our Societies — A Reply to "Quality and Quantity."
M. H. Feldman, D.D.S.
Concerning the Teeth.
[The Dental Register]
Contents
Event and Comment.
The Shortage of Platinum.
Efficiency in Tooth Brushing.
Fixed Laws Governing Dental Amalgams.
Diagnostic Methods for Anesthesia.
The Dentist and the Orthodontist.
Some Refraction
Some Refractories Used in Dentistry.
Succinimid of Mercury.
Indents.
[The Texas Dental Journal, February, 19 16]
Original Communications
The Business Side of Dentistry.
Digitized by V:iOOQIC
AN EPITOME OF CURRENT DENTAL AND MEDICAL LITERATURE 257
With Our Contemporaries
Malplaced and Impacted Third Molars.
Pulpless Teeth.
Hilitary Surgery.
Cavity Preparation.
Dr. Edward Livingston Trudeau.
The Educational Value of Oral Hygiene in the Army.
Advice to Those About to Wear Artificial Teeth.
[The IfUernatianal Journal of Orthodontia, February, 1916]
Original Articles
Students as Orthodontists. By Adelbert Femald) D.M.D., Boston, Mass.
Jurisprudence. By Elmer D. Brothers, B.S., L.L.B., Chicago, Ills.
♦A Plea for Conservation of the Cementum. By F. Hecker, B.S., D.D.S., A.M., M.D.
History of Orthodontia (Continued). By Bemhard W. Weinberger, D.D.S., New York City.
Case History. By H. C. Pollock, D.D.S., St. Louis, Mo.
A PLEA FOR CONSERVATION OF THE CEMENTUM
By F. Hecker, B.S., D.D.S., A.M., M.D.
Director of Research Laboratory of the Dewey School of Orthodontia, Kansas City, Mo,
The object of this paper is a plea for less heroic instrumentation and
greater conservation of the cementum on the roots of teeth affected by
pyorrhea alveolaris. Wlien a failure of union between the peridental
membrane and the root of the tooth occurs after heroic instrumentation
has been instituted, it is not because the peridental membrane has been
removed in its entirety for, on scaling the roots of the teeth, only the
ends of the fibers attached to the cementum have been cut and partially
removed, while the fibers of the alveolar surface are often intact. The
failure of union results because the operator, in his heroic scaling, has
removed the basal layer of the cementum, and the dentin of the root of
the tooth is exposed. Even if a few islands of the cementum are left on
the root of the tooth, the area of destruction of the cementum is propor-
tionately so great that the remaining cementoblasts (or lacunae) are un-
able to regenerate the cementum tp such an extent as to replace the
destroyed cementum.
The popular teaching at the present is that the peridental membrane
carries in its substance the cementoblasts and that the development of the
cementum is dependent on the peridental membrane. This teaching the
author believes is not correct, for the reason that the peridental mem-
brane histologically is an exact counterpart of the periosteum. One
needs to do nothing more than examine a slide made from a section which
shows the root of the tooth in situ in the alveolus to be convinced that
such is the case. And further, the author believes it is impossible fqr one
to place the pointer of the eye-piece at a definite point, and state that the
tissue at one point is peridental membrane, while that at an adjoining
Digitized by
Google
258 THB DBNTAL DIGBST
point it is periosteum, for histologically there is no evidence on which one
can make an actual diflferentiation. In lieu of the work done by Mac-
Ewen of Scotland, in which he shows, by experimental evidence, that
the periosteum does not carry osteoblasts in its substance, and further
that the function of the periosteum relative to the formation of new bone
is that of a limiting membrane; the author, in his examination of a large
number of slides of sections which he has made of the root of the tooth in
the alveolus taken from the human mouth in the morgue, has not, up to
the present, observed any free cells in the substance of the peridental
membrane in the vicinity of the cementum, which morphologically re-
sembles the cementoblasts described by Black and Noyes. The periden-
tal membrane, the author believes, is a limiting membrane for the cemen-
tum and the alveolus. Vitally, the fibers of the peridental membrane
have a direct affinity for the cementum and if the cementum is absent the
fibers do not find a surface which is adapted to their need, and no union
occurs.
[Dominion Denial Journal, February, 1916]
Original Communicalions
Anocain. By E. W. Paul, D.D.S., L.D.S., Toronto.
The Advantages and Risks of Combined Local and General Anaesthesia. By W. H. B.
Aikins, M.D., Toronto.
The Combined Use of Local and General Anaesthetics and the use of Adrenalin. By Dr.
D. J. Gibb Wishart, Toronto.
Mr. Barker's Method of Spinal Anaesthesia. By C. H. Hair.
Gas and Oxygen Analgesia. By Dr. H. R. Holme, Toronto.
Ether. By Dr. J. F. L. Killoran, Toronto.
*The Methods of Resuscitation in Anaesthesia. By Dr. T. R. Hanley, Toronto.
Anaesthetics. By E. W. Paul, D.D.S., L.D.S., Toronto.
It Pays to Care for the Soldiers' Teeth. By Lieut.-Col. Hendrie.
THE METHODS OF RESUSCITATION IN ANAESTHESIA
Dr. T. R. Hanley, Toronto
The methods of resuscitation have been interpreted by me to mean
the treatment of the dangers which arise during anaesthesia as well as the
actual treatment of suspended animation.
I intend to bring to your notice some of the commoner dangers arising
during anaesthesia and follow them up by suggestions which have proven
in my experience to be most beneficial.
Broadly speaking, then, the dangers met with in anaesthesia may be
divided into two groups:
(i) Respiratory failure.
(2) Cardiac failure.
The Causes of Respiratory Failure —
I. Blocking of the air passages by foreign materials, such as blood,
vomitus, mucus, etc.
Digitized by V:iOOQIC
AN EPITOME OF CURRENT DENTAL AND MEDICAL LITERATURE 259
Treatment — must be preventive —
(a) Always ask the patient before beginning your anaesthetic about
the presence of artificial teeth.
During the introduction try and prevent vomiting. If the patient
does vomit, turn his head to one side and tile the shoulder; if necessary.
lower the head of the table.
(b) Mucus. — If it is anticipated for any reason, such as bronchitis,
tuberculosis, give atropine gr. i / loo half an hour before operation. If
the patient does develop mucus and the accompanying cyanosis tends to
become alarming, give the patient more air or oxygen, and use more
anaesthetic proportionately. If the patient stops breathing use Shafer's
method of resuscitation.
(c) Blood, — Try to get it to drain out by placing the head well over
to the side. Put a piece of gauze in the corner of the mouth. In mouth
operations use Johnston's apparatus and pack the throat. In nose
operations, such as radical antrum, place a plug in the posterior naso-
pharynx.
(d) Anatomical Ahnormalities. — Spurs, adenoids, goitre, etc.
(e) Spasm of the muscles at the base of the tongue. Spasms of the
aryteno-epiglottidean folds in the larynx and general spasm of the respira-
tory muscles.
See that the head is in the best possible position for free breathing. Let
them assume the natural position in which they sleep. Some patients are
roimd shouldered and breathe better with a pillow under the head. In
some cases it is well to place the nasal tube in position reaching as far as
the upper border of the epiglottis. Sometimes, holding the jaw forward
from behind the angle so that the tongue muscles are on the stretch, tends
to raise the base of the tongue from the posterior pharyngeal wall — and
will suffice. As a last resort, use the mouth gag and pull the tongue for-
ward with a pair of forceps.
If spasm of the muscles of the lamyx is due to a flake of mucus, which
is sometimes the, case, let the patient have a few breaths of air and do not
push the anaesthetic. If due to irritation from strong vapor, give more
air or oxygen.
(f) Position of the Patient, — ^Absolutely prone as in laminectomy,
trephining, cerebellar tumor, kidney operations, etc. ; the obvious treat-
ment is to inunediately change the position.
(g) Toxic action of the anasthetic,
1. Early. — Relative overdose.
2. Late. — Overdose causing a paralysis of the centre in the medulla.
In either case, act quickly — open the jaws, pull the tongue forward,
sweep the fingers around the. posterior pharynx and see that no foreign
Digitized by
Google
260 THE DENTAL DIGEST
matter is blocking the air passages. Try artificial respiration, and if air
is entering the lungs no further anxiety may be felt on that point. If air
does not enter, push the tongue forward from the base by placing the
forefinger in the mouth and again try your artificial respiration. If that
doesn't help matters, tracheotomy should be performed and artificial
respiration carried on for at least one hour, providing the patient has not
revived in the meantime.
At the same time as you are using Sylvester's method have an assistant
use rhythmical tongue traction (Laborde).
(h) Where shock is anticipated, or the general condition of the pa-
tient is below par, it is well to start interstitial salines at the beginning of
the operation, and not wait until the patient is in extremis.
(i) In sudden severe haemorrhage, stop your anaesthetic, give your
salines by the Aeedle into the vein, and lower the head of the table.
(j) Exophthalmic operations, mastoids empyema, erect posture for
nose and throat operations, use very light anaesthesia. Do not abolish
the reflexes completely.
Cardiac failure may be due to:
1. Extrinsic causes other than overdose.
2. Toxic action of the anaesthetic.
Extrinsic causes,
(a) Fright — at the very beginning of the anaesthetic — a very common
cause, you will remember, in pre-anaesthetic days; use morphia gr. J- J
before the operation. Try always to win the confidence of your patient.
(b) Feeble condition of the patient from exhausting diseases, consti-
tutional dyscrasia, etc. Proper choice of anaesthetic, care in the adminis-
tration and proper preparation beforehand will obviate these to some
extent.
(c) Shock from operation, such as a re-section of bowels, cutting the
spermatic cord, rectal operations, etc. Reflex of threatened vomiting,
especially with chloroform, and position of the patient must all be thought
of and properly met.
Toxic action of ancesthetic.
1. Syncope in the early stages, more especially with chloroform,
owing to relative overdose or cardiac inhibition caused by strong vapor
irritating the laryngeal branches of the vagus nerve.
2. Later syncope from overdose, causing paralysis of the centre in
the medulla or of the cardiac muscle and its intrinsic ganglia.
Treatment: Lower the head (invert children), open the mouth, draw
out the tongue, and while you do Sylvester's method of artificial respira-
tion have an assistant do rhythmical tongue traction of Laborde.
Have the nurse give whatever stimulants you may think necessary. I
Digitized by V:iOOQIC
AN EPITOME OF^CURRENT DENTAL AND MEDICAL LITERATURE 261
prefer camphor grs. lo, pituitary extract i cc, or strychnia gr. ^ in the
order named.
If the abdomen is open, have the surgeon gently massage the heart.
Electrical stimulus to the side of the neck is recommended in the hope
of influencing the phrenic nerve, but the result is doubtful, considering, as
we must, the close proximity of the vagus.
The pulmotor, lauded so greatly a few years ago, has, I think, been
relegated to the museum, but a new instrument has been devised which
promises good results and will bear a thorough trial.
Injection of strychnia directly into the heart muscle may be done as a
last resort, but I don't see that it has much to commend it.
[Oral Health J February, 19 16]
Contents
Photograph, Dr. Thomas L. Gihner, Chicago, 111.
*Chronic Oral Infections and Their Relation to Diseases in Other Parts. By Thos. L.
Gihner, M.D., D.D.S., Sc.D., Chicago.
Resume of Discussion of Dr. Gilmer's Paper.
Local Anesthesia With Use of Anocain. By B. R. Gardiner, D.D.S., Toronto.
Impressions of the Twenty- third Annual Meeting of American Institute of Dental Teachers.
By Thomas Cowling, D.D.S., Toronto.
Address Delivered to Toronto Dentists by Major Clayton, Acting Chief Dental Surgeon,
Canadian Army Dental Corps.
Great Need for Reading Matter at the Front.
Splint for Fractured Mandible. By William Heqidon Pearson, D.D.S., Norfolk. Va.
Chicago Dental Society's Fifty-second Meeting. By W. B. Amy, D J).S., Toronto.
CHRONIC ORAL INFECTIONS AND THEIR RELATION TO
DISEASES IN OTHER PARTS
By Thomas L. Gilmer, M.D., D.D.S., Sc.D.
The preliminary report made by Dr. A. M. Moody, bacteriologist, St.
Luke's Hospital. This study is for the purpose of determining, so far as
possible, the effect on animals injected with strains of freshly isolated
streptococci from chronic alveolar abscesses. In this work strains of
streptococcus viridans, isolated from alveolar abscesses in fifteen patients
suffering from various pathological conditions, have been injected into a
total of forty-seven rabbits.
The streptococcus viridans in every instance is the predominating
organism, and that in only one instance was the staphylococcus found,
and then just an occasional colony was present.
Of the fifteen patients with chronic alveolar abscesses six had also
pyorrhea; eight had rheumatism, one each acute gastric ulcer, neuritis,
myocarditis, mitral endocarditis, and nephritis. Rosenow's technique,
in a large measure, has been followed in these studies. The exceptions
are two, i. e. (i) The doses of streptococci have, in all instances, been less
than two billion, and in most cases between one-half and one billion.
Digitized by
Google
262 THX DSNTAL DI0B8T
These are approximate numbers. (2) The animals have been allowed to
live a longer time after injection.
The gross pathological lesions present in the forty-seven rabbits are
given below. The microscopical examinations of these have not as yet
been completed, but in so far as these observations have progressed, the
gross diagnoses have been confirmed. Following is the table of Rosenow
in the animals autopsied:
Appendicitis was present in 2%
Hemorrhage of stomach 40%
Ulcer of stomach 13%
Ulcer of duodenum 2%
Hemorrhage or pus in gall bladder 13%
Hemorrhage in pancreas 15%
Hemorrhage into peritoneum 5%
Arthritis and periostitis 40%
Endocarditis .....* 28%
Pericarditis 5%
Myocarditis 5%
Nephritis 30%
Hemorrhages or other lesions of the lungs 10%
Hemorrhages into the skin 2%
Tongue 0%
Eye 4%
Hemorrhages into jaw 20%
The hemorrhages into the jaw have not been previously described,
except in a paper on experimental scurvy by Jackson and Moody before
the American Association of Pathologists and Bacteriologists in St. Louis,
April, 1915. These hemorrhages occur beneath the periosteum of the
lower jaw before the central incisors. Occasionally they occur on only
one side, but may be present on both.
This series is too small to draw any definite conclusions. They,
however, indicate a certain amount of selective localization for the strep-
tococcus viridans isolated from chronic alveolar abscesses. To be more
specific, these organisms produced gross evidences of muscle involvement
in 60 pfer cent., joint and bone, aside from the jaw, in 40 per cent.; stom-
ach in 40 per cent., kidney in 30 per cent., and jaw in 20 per cent.*
We occasionally find what I have termed atypical alveolar abscesses,
the lateral abscess of black on the sides of the roots of teeth having live
pulps.
Black believed that these abscesses were due to acute pyorrhea alveo-
laris attacks, the infection extending from the gingival border root-wise
through a narrow channel on the side of the root.
Since Moody and I have found in 20 per cent, of our cases sub-perios-
teal hemorrhages in the jaws, I am inclined to believe that similar hemor-
*The above experimental work was done in St. Luke's Hospital Laboratory.
Digitized by V:iOOQIC
AN BPITOME OF CURRENT DENTAL AND MEDICAL LITERATURE 2<»3
rhages may be found in the peridental membrane. If hemorrhages are
caused by the streptococcus in the periosteum, may it not cause a like
condition in the peridental membrane as well?
Since the area involved in hemorrhage may later become abscessed,
then if the peridental membrane participates in like hemorrhages we have
a seeming scientific solution of the atypical alveolar abscess. As yet we
have not examined the peridental membrane for hemorrhages, but intend
to look for them in this organ.
[New York Medical Journal, February 12, 19 16]
EMETINE IN HEMOPTYSIS IN CHEST WOUNDS
J. Dupont and J. Troisier, in Btdletins el mlmoires de la Socitti midicale
des hSpiiaux de Paris, November 27, 1914, report three cases of pene-
trating rifle bullet wounds of the thorax with hemoptysis, in which eme-
tine was used with results apparently as satisfactory as those already re-
ported by several observers of the hemoptysis of pulmonary tuberculosis.
In the first case, with a wound at the base of the left lung, arterial blood
was being abundantly expectorated upon admission, and the man was
dyspnoeic and oppressed, and presented signs of a slight hemothorax.
The condition persisting throughout the night in spite of the dressing
applied, a subcutaneous injection of two thirds of a grain (0.04 gram) of
emetine hydrocholoride was given. In the afternoon the bloody expec-
toration showed marked reduction, and in the succeeding night ceased
almost completely. A week later, the patient was discharged in excellent
condition. In a second similar case, a single injection of emetine was
also followed in a few hours by cessation of bloody expectoration. In the
third case, that of a man wounded a week before, bloody expectoration
had been continuous, and auscultation revealed a tendency to consolida-
tion of the lower portions of the lungs, with crepitant riles.
A MOUTH WASH IN GRIPPE
Dr. Beverley Robinson, in an original communication on the Treat-
ment of grippe in this issue of the Journal, page 293, recommends as a
mouth wash and gargle the well known liquor antisepticus alkalinus.
Doctor Robinson informs us that even more efficacious is a mixture de-
vised by his friend, Dr. Augustus Wadsworth, and published in a com-
munication, Mcftith Disinfection, in the Prophylaxis and Treatment of
Pneumonia, in the Journal of Infectious Diseases for October, 1906, page
774. The formula is as follows:
]J Sodium chloride (C.P.) 5ss;
Sodium bicarbonate (C. P.) gr. x;
Water (dist.) gij;
Glycerin gj;
Digitized by
Google
264 THE DENTAL DIGEST
Alcohol . Jv;
Menthol / «*K^-J.
Oil of wintergreen gtt. iij;
Oil of cinnamon gtt. ij;
Oil of eucalyptus gtt. v;
Tinct. cudbear 5Jss;
Tinct. rhatany 5^-
M. Sig.: Dilute with an equal volume of water.
In preparing-.this solution, remarks Doctor Wadsworth, the salts should
be dissolved in the water before adding alcohol. Even when carefully
made up, a cloudiness or precipitate may appear in the solution, on ac-
count of the presence of rhatany. By adding two or three of the flavoring
oils a less pronounced taste is obtained than when only one is used.
[New York Medical Journal^ March 4, 191 6]
RECOVERY OF STREPTOCOCCUS VIRIDANS FROM NEW YORK STREET DUST
By William C. Thuo, M.D., New York
{From the Departmeni of Clinical Pathology, Cornell Medical College, New York.)
In view of the almost universal presence of Streptococcus viridans in
infections of the wral cavity and of the respiratory tract — note the work
of Hastings, Cecil, and others and its almost constant presence on the tips
of the roots of teeth extracted from patients with chronic infectious arthri-
tis, the recovery of this particular microorganism from the out of door dust
seems a matter worthy of investigation. While we believe that such in-
fections are transmitted, in the great majority of cases, from person to
person by contact, sneezing, and expectoration, still it seems to be within
the range of possibility that the streptococcus may be spread by the dust.
That this dust is inhaled in large amounts no one will deny.
The true Streptococcus viridans has been recovered from dust collected
from a balcony twenty feet above the street level, and some of the
strains are pathogenic for rats. It is possible, too, that this streptococcus
may come from the dried feces of domestic animals, particularly the horse,
since some of the strains fermr.nt some of the same carbohydrate as Strep-
toccocus equinus does, for example.
[Journal American Medical Association, February 12, 1916]
THIONIN as a diagnostic stain in PYORRHEA ALVEOLARIS
Martin Dupray, B.S., M.S., Columbia, Mo.
I have seen no mention in the literature on endamebas in pyorrhea
alveolaris of the use of thionin as a diagnostic stain for the endameba.
In the past fifteen months while doing microscopic work for several den-
tists in this city, it has been my privilege to examine a large number of
Digitized by
Google
AN EPITOME OF CURRENT DENTAL AND MEDICAL LITERATURE 265
slides of alveolar exudate for endamebas and other organisms. Most of
the preparations were stained before being examined, and the stain used
in the majority of cases was thionin. The stain was prepared according
to the following formula:
Thionin 0.5 gm.
Distilled water loo.oc.c.
Phenol (carbolic acid) crystals 2.0 gm.
This solution must be prepared fresh every three or four months.
To prepare the slide, a smear is made of the exudate as with other pus
and dried in the air. The smear is then fixed in the flame and stained a
few seconds while still warm with the thionin solution. The stain is
washed off with water and the slide dried. It may be mounted in balsam
with a cover glass, or examined direct in immersion oil as desired. The
endamebas are stained quite distinctly by this method. The cytoplasm
is stained a Ught purplish violet and the nuclei a deeper reddish violet.
Ingested blood corpuscles and other material undergoing digestion in the
body of the organism are stained nearly black. The pus cells in the smear
are stained a light blue, with their nuclei a deeper blue. Bacteria are
also well stained, the fusiform bacilli and spirillas being especially plain.
The endamebas stand out quite distinctly in the smear, and are easily
recognized. A person accustomed to the use of the microscope can usually
see them easily with the low power (two- thirds or 16 mm.) objective, using
the high power only for verification; hence a considerable area of the smear
can be covered in a short time.
I have found the stained preparations much more reliable than un-
stained preparations, and much quicker, on account of the time con-
sumed in examining an unstained slide. Thionin has also given more
uniform results than the double staining method with fuchsin and methy-
lene blue, and the stain is made more quickly and easily.
This stain does not give good histologic pictures of the endamebas and
is recommended only as a diagnostic stain, for which purpose it gives very
plain pictures of both the endamebas and the bacteria.
[Journal American Medical Association ^ February 19, 1916]
THE TOXITY OF ARSENOUS AND ARSENIC ACID
Compounds of arsenic are becoming so prominent in therapy, and the
t3T>es of arsenic products for use in medicine have become so diverse, that
any information bearing on their possible mode of action should be wel-
come. The familiar derivative of arsenic which early found its way into
use both as a drug and as a poison is the white arsenous oxid, often itself
spoken of simply as arsenic. The salts of arsenous add are also employed,
as in Fowler's solution. Arsenic action is not due to the element, but to
Digitized by
Google
2M THB DBNTAL DIGEST
the ion of arsenous acid, HjAsO,. Organic arsenic compounds in which
the metallic atom is attached directly to carbon are only feebly toxic.
In the course of time, within the body they seem to yield more or less
arsenous acid, a reaction which may suffice to explain any pharmacologic
potency possessed by the organic derivatives. It is a somewhat unex-
pected fact that the closely related arsenic acid H3ASO4, its anhydrid
and its salts are far less poisonous than is arsenous add. This statement
has now and then been disputed, but only recently again substantiated
at the pharmacologic institute of the University of Berlin by Joachimo-
glu. The relatively greater toxicity of arsenous in comparison with
arsenic acid could be demonstrated by the proportion of 10:6 in the case
of the lethal dose required for intravenous injection in animals. Perfusion
experiments with isolated frogs' hearts indicated the arsenous compounds
to be 300 times as harmful as those of arsenic acid. In the case of the
isolated intestine the contrast, though plain, was not equally striking.
This has raised the question why there should be a marked disproportion
in the relative toxicity of comparable quantities of arsenic and arsenous
acids, depending on the mode in which the test is made. The explanation
proposed is as follows: The toxicity of the arsenic add depends on the
reducing power of the tissues with which it comes into contact. By this
means it is converted into the very poisonous arsenous compound. Some
individual organs or tissues have comparatively slight reducing potency.
In the isolated heart, for example, arsenic acid exhibits little toxidty.
Throughout the living organism as a whole the reduction of arsenic add
appears to be far more readily accomplished; hence, after intravenous
administration of the ordinarily less nocuous derivative, it may become
more toxic so promptly by conversion to arsenous acid that the real diflfer-
ence between these related arsenic derivatives is no longer conspicuous.
This may also explain some of the uncertainty or confusion which has
existed in the past in respect to the comparative action of the two sub-
stances.
[Journal American Medical Association, February 19, 1916]
(Afnerican Journal Medical Sciences)
TONSILLAR ENDAMEBIASIS AND THYROID DISTURBANCES
Tonsillar lesions of an infective cryptic character were found by the
authors in 22.8 per cent.; and nasal together with tonsillar lesions existed
in 90 per cent, of 362 goitrous individuals examined from this standpoint.
In typically diseased tonsils, out of thirty-four cases examined micro-
scopically, 97 per cent, were found to harbor Endanueba gingivcUis (gros)
in the tonsillar crypts. Of sixteen individuals of this group who after
treatment by means of emetine hydrochlorid were reexamined, thirteen, or
Digitized by
Google
AN EPITOME OF CURRENT DENTAL AND MEDICAL LITERATURE 267
8 1 per cent., were shown no longer to have eYidamebas in the cryptal con-
tents. In twenty-three persons to whom emetine was administered a
reduction in the bulk of the goitre was appreciable in eighteen; and of
seven dysthyroid cases included in this group of those treated, six were
benefited in degrees varying from slight amelioration to apparent cure.
{Archiv fiir Kindnheilkunde, Stuttgart^ November 2, 1915)
mCH ARCmNG PALATE
Landsberger comments on the disturbances almost inevitable when
the palate runs up abnormally high. The nasal passages are interfered
with by it and mouth breathing is inevitable. It also entails a ten-
dency to a vacuimi in the nasopharynx wl^ch acts injuriously on the ear
and on the local circulation. The spyace inside this part of the skull is also
encroached on by the high palate. The disturbances from the latter are
often ascribed to the adenoids frequently found with it. Another serious
trouble from it is the resulting abnormal development of the teeth. The
germinal buds do not develop centrifugally, as in normal conditions, but
straight downward. The condition can be remedied by straightening the
roof of the mouth, forcing its sides apart and thus bringing the concave
palate down to be more nearly flat. He gives illustrations of a spring
and screw apparatus for the purpose. It is worn between the teeth, forc-
ing the rows apart. It does not interfere with speaking or eating, and an
actor wore it without interfering with his professional work. The benefit
in children was almost miraculous in some cases. Deafness subsided, as
also asthma and the headaches which had tormented the children for
years. Abnormal salivation was also arrested, and a tendency to coryza.
tonsillitis and bronchitis, while the general growth was promoted. All
these changes are readily explained by the differences seen in the roentgen-
ograms taken before and after wearing the brace.
[Journal American Medical Association, March 4, 1916]
THE INTERRJELATION BETWEEN SALIVARY AND GASTRIC DIGESTION
Physiologists have long known that the starch-digesting enzyme pre-
sent in the saliva of man is destroyed as soon as it is exposed to even small
concentrations of **free" hydrochloric add, or, in terms of modem chemi-
cal interpretation, hydrogen ions present in the stomach. From the
standpoint of a useful performance on the part of the starch-digesting
saliva, the ready inhibition of its effectiveness as a digestive agent was
somewhat mystifying when it was first discovered; for the duration of
amylolytic activity appeared to be restricted essentially to the very brief
period during which the foods are retained in the mouth, masticated and
swallowed. Subsequently it was ascertained that the actual sequence of
events within the stomach does not compel an immediate mixing of the
Digitized by V:iOOQIC
268 THB DENTAL DIOBST
entering contents with the gastric juice which is being secreted. The
mass that is swallowed in successive portions accumulates at first in the
fundus of the stomach; and since in the absence of vigorous muscular
movements in that region the contents are penetrated with great difficulty
by the gastric secretion which is continually being poured out by the
walls of the stomach, salivary digestion can actually proceed for a con-
siderable time without serious interruption. In view of the rapidity with
which the salivary enzyme can convert starch into soluble sugar, the pre-
liminary digestion of carbohydrates can therefore usually be completed
before destruction of the effective agent in the saliva takes place. Dr.
Maxwell of the physiologic laboratory at the University of Melbourne,
has suggested a further fimction of the salivary enzyme which he believes
to be of importance for the later digestive processes. It has long been
known that many substances in suspension or in coUoidal solution have
the power of absorbing enzymes, thereby inhibiting their activity. Max-
well has found experimentally that although unboiled starch administered
in the form of intact grains does not hinder the action of pepsin, peptic
digestion may be delayed in the presence of colloidal starch solutions
through absorption of the proteolytic enzyme. The time interval for the
peptic digestion may, for example, be increased fourfold in the presence
of a 2 per cent, starch solution. There is a stage in the progressive di-
gestive disruption of the starch molecule at which the capacity of absorp-
tion of pepsin is lost. This is coincident with the appearance of dextrins,
even before sugars are formed. In accord with the foregoing it is actually
found that cooked farinaceous foods — rice, potato, bread, porridge, etc.
— all hinder peptic digestion if they are not first subjected to the salivary
digestion. The inhibition of peptic activity by carbohydrates like gum
acacia is not prevented by a previous contact with saliva for the reason
that they are not digested by it. The positive feature to which Maxwell
has drawn attention has been summarized by the statement that the
saliva of man, by virtue of its enzyme ptyalin or amylase, plays a consid-
erable part in aiding gastric digestion by hydrolyzing colloidal starch
which would otherwise absorb pepsin.
FACTS ABOUT THE BEHAVIOR OF THYMOL IN THE BODY
In connection with the treatment of hookworm disease and comparable
forms of intestinal infection with parasitic invaders, considerable promi-
nence has been given to the use of thymol (methylisopropylphenol), a
phenol derivative obtained commercially from oil of ajowan and occurring
in oil of horsemint, oil of thyme and some other volatile oils. Thymol is
an antiseptic comparable in many ways to phenol and the cresols, but it is
less soluble in water, and for this reason has been supposed to be absorbed
Digitized by
Google
AN EPITOME OF CURRENT DENTAL AND MEDICAL LITERATURE 269
with greater difficulty from the alimentary tract. The latter assumption
has made it seem more valuable as an antiseptic for use in the gastro-
intestinal tube because of the protection from direct intoxication by the
drug thereby afforded to the organism as a whole while the parasite is
being destroyed. Owing to the solubility of thymol in oils, it has re-
peatedly been urged that, when the drug is U5td. fatty substances should
be avoided in the diet, in order to avert nndue:abs^rption.of.thc. l^r^e.
doses required for anthelmintic effects. One nught expect th9,tXccttii-
j)ound with these prop)erties wQuld reappe^ar. in considerable jqygyajities
in the feces after its administratioi^ byViral paths. Inwstiga?tions.jii the
Hygienic Laboratory of the U. S. Public Health Service have shown,
however, that only insignificant amounts of ingested thymol are excreted
in this way. This would indicate that thymol is almost completely ab-
sorbed from the alimentary tract and must therefore be oxidized in the
body or excreted in the urine. Seidell has therefore directed attention
to the behavior of the compound after absorption. It has long been
known that absorbed thymol may reappear in the urine as a glycuronate,
just as other alcoholic derivatives conjugate with glycuronic acid in the
metabolism. A careful study of the fate of thymol gave promise of dis-
closing the mechanism of its action on hookworms, and consequently, of
indicating the path to be followed in developing drugs of greater potency
and safety than thymol. Even now it is being urged that the oil of
chenopodium or oil of American wormseed be thus employed. The
supply of thymol is said to be extremely limited at present, and the oil of
chenopodium is regarded as generally safer. Seidell has found that less
than so per cent, of the thymol administered either to experimental ani-
mals or to human patients who received the thymol treatment for hook-
worms reappears in the urine. This result, in connection with the pre-
viously mentioned experiments on the determination of thymol in the
feces, shows that of the thymol administered, from one half to two thirds
is apparently destroyed or fixed in the body. A similar fate is suggested
for compounds of related type, such as the simpler phenols. No satis-
factory explanation has as yet been found for this apparent disappearance
of administered phenols. With respect to the fraction that is not reex-
creted as glycuronate, it has been surmised that it may be temporarily
fixed by the tissues or eliminated by volatilization with the expired air.
This is mere conjecture without any supporting evidence. From a
practical standpoint there is significance in Seidell's finding that the sim-
ultaneous administration of olive oil with thymol apparently caused
very slight if any effect on the percentage of excreted drug. In his opin-
ion it is a question, therefore, whether oils really increase the amount of
absorption or only the rate.
Digitized by
Google
270 TUB DBKTAL DIGEST
[Medical Record, February 19, 1916]
CHLORAMINE IN THE TREATMENT OF WOUNDS OF THE MOUTH AND JAWS
A. R. Fisher says that the septic character of all gunshot wounds in-
volving the mouth and the disadvantages attending the use of the com-
mon antiseptics, led.hioa.tot try chloramine (toluene sodium sulphochlora-
raide) in se^nfn.•*dL3es; frxe!Ke|ngfcompound fractures of the jaw and two
'..••:• flesh jwptmds viyqiyiife3the.inojith.. A two ppr^^nt. aqueous solution of
• • ftn^agtotV^ vS^m Icm jrrigajbon; jffi^&A yf^t&mwi out every hour during
the ^^;&nrl:a8*ofCrn as^ possible ^ucui^liie night. Chloramine besides
being V^Joi^firfiiVantiseptic^his jtlfe of penetrating the tissues,
and is not so readily neutralized by albuminous discharges as the simpler
chemical antiseptics. It is bland and non-irritant. While the number
of cases treated was small the results were most encouraging.
[Denial Items of Interest, March, 1916]
Exclusive ContrilnUions
Antihygienic Conditions of the Oral Cavity and Dental Maladies, May Lead Not Only to
Tuberculous Infection but to Many Other Systemic Maladies. By N. L. Castiglia, D.D.S.
The Etiology and Treatment of Pyorrhea Alveolaris. By G. Chisohn, D.D.S.
Further Facts Regarding Succinimide of Mercury as a Cure for Pyorrhea. By Dr. Georpc
H. Reed, A.A., Dental Surgeon, U.S.N.
Ther Average Dentist and Root Canal Work. By Samuel Lang, D.D.S.
Orthodontia
Dr. Edward H. Angle's Pin and Tube Appliance. By A. H. Ketcham, D.D.S.
Prosthodontia
Anatomical Dentures. By Seimaro Shimura, D.D.S.
Resiliency as Opposed to Rigidity in Artificial Teeth. By R. Morse Withycombe.
Society Papers
Therapeutic and Surgical Treatment of Roots and the Adjacent Tissues. By J. F.Biddle, D.D.S.
The Restoration of Masticatory Function with Carved Gold Inlays. By Rodrigues Otto-
lengui, M.D.S., LL.D., D.D.S.
An Informal Talk on Inlays. By'Dr. E. S. Tracy.
Oral Hygiene and Its Relation to Better Health Conditions. By J. P. Delvin, D.D.S.
[British Dental Journal, February 16, 1916]
Original Communications
Valedictory Address. By G. Northcroft, L.D.S. Eng., D.D.S. Mich.
A Case of Impetigo Contagia cured by the Extraction of Septic Teeth. By W. Nicholson,
L.R.C.P., M.R.C.S., L.D.S. Eng.
Alum Wool. By J. T. Hall, L.D.S.L
Gestant Composite Odontomes. A Case Reported by Mr. A. Barritt, L.D.S. Eng.
Abstracts and Translations
Mastication and Food Utilization.
Sterilizing Dental Instruments.
Oxpara for Filling Root Canals.
Case of Associated Jaw and Lid Movement. By Captain A. W. Ormond, F.R.C.S.
Digitized by
Google
SOCIETY NOTES 271
SOCIETY NOTES
Alabama.
The next meeting of the Alabama Dental Association will be held at Mobile, Ala., April
II, 1916. — ^J. A. Blue, Binningham, Ala., Secretary,
Arizona.
The next meeting of the Arizona Board of Dental Examiners will be held in Phoenix,
Ariz., October 9-15, 1916. — Eugene McGuire, 302 Noll Bldg., Phoenix, Secretary.
Connecticut.
The Connecticut State Dental Association will meet in New London, Conn., at Hotel
Griswold, June 13-15, 1916. — Elwyn R. Bryant, New Haven, Conn., Secretary.
Florida.
The next meeting of the Florida State Dental Society will take place at Orlando, Fla.
June 21, 1916. — M. C. Izlar, Ocala, Fla., Secretary.
Georgia.
The forty-seventh annual meeting of the Geoi^gia State Dental Association, will be held
at Macon, Ga., June 8-10, 1916, beginning at 11 a.m. Thursday, June 8th. — M. M.
Forbes, 803 Candler Bldg., Atlanta, Ga., Secretary.
Idaho.
The next meeting of the Idaho State Dental Society, will be held at Boise, June, 1916. —
R. J. Cruse, Pocatello, Idaho, Secretary,
Illinois.
The Illinois State Dental Society will hold its next meeting at Springfield, 111., May 9-1 2»
1916. — Henry L. Whipple, Quincy, 111., Secretary.
Indiana.
The fifty-eighth annual meeting of the Indiana State Dental Association will be held at
the Claypool Hotel, Indianapolis, May 16-18, 1916. — A. R. Ross, Lafayette, Secretary.
Iowa.
The next meeting of the Iowa State Dental Society will take place at Des Moines, Iowa,
May 2-4. — H. A. Elmquist, Des Moines, Iowa, Chairman of Exhibit.
Kentucky.
The Kentucky State Dental Society, will hold its next meeting at Louisville, July 24,
1916. — W. T. Farrar, 519 Starks Bldg. Louisville, Ky., Secretary.
The next meeting of the National Dental Association will be held in the ist Regiment
Armory, Louisville, Ky., July 25-28, 1916. — Otto U. KiNG„Huntington, Ind., Secretary.
Massachusetts.
The next meeting of the Massachusetts Dental Society will be held in Boston, Mass.,
May 3-5, 1 916. — A. H. St. C. Chase, Boston, Mass., Secretary.
Michigan.
The Michigan State Board of Dental Examiners will meet in the Dental College at Ann
Arbor, June 19, 1916, at eight o'clock a.m.; for application blanks apply to E. O.
Gillespie, Stephenson, Mich., Secretary-Trecuurer.
Mississippi.
. The next meeting of the Mississippi Dental Association will be held at Jackson, Miss.,
May 1-3, 1916. — M. B. Varnado, Osyka, Miss., Secretary.
Digitized by V:iOOQIC
272 THE DENTAL DIGEST
Nebraska.
The Nebraska State Dental Society will hold its next meeting in Lincoln, Nebr., May
16-18, 1916. — H. E. King, Omaha, Nebr., Secretary,
New York.
The Dental Society of the State of New York will hold its next meeting at the Hotel
Ten Eyck, Albany, N. Y., May 11-13, 1916.— A. P. Burkhart, 52 Genesee St., Albany,
N. Y., Secretary.
Pennsylvania.
The fifty-third annual meeting of the Lake Erie Dental .Association will be held at Hotej
Bartlett, Cambridge Springs, Pa., May iSr-jo, 1916 — ^J. F. Smith, 120 W. i8th St., Erie,
Pa., Secretary.
The thirty-fifth annual meeting of the Odontological Society of Western Pennsylvania
will be held at the Monongahela House, Pittsburgh, Pa., Tuesday and Wednesday, April
II and 12, 1916.— King S. Perry, 719 Jenkins Bldg., Pittsburgh, Pa., Secretary.
The next regular examination of the Pennsylvania Board of Dental Examiners will be
held in the Musical Fund Hall in Philadelphia, and the College of Pharmacy Building
in Pittsburgh, on June 14-17, 19 16. The practical work vnW be held at the Philadelphia
Dental College in Philadelphia, and the University of Pittsburgh in Pittsburgh, on the
first day, June 14th, the operative work being held at eight- thirty a.m., and the prosthetic
work at one-thirty p.m. — Alexander H. Reynolds, 4630 Chester Ave., Philadelphia,
Pa., Secretary.
South Carolina.
The forty-sixth annual meeting of the South Carolina State Dental Association will be
held at Chick's Springs, So. Car., July 11-13, 1916. — Ernest C. Dye, Greenville, So.
Car., Secretary.
TlEXAS.
The Texas State Dental Association will hold its next meeting at Dallas, Texas, May
9-12, 1916. — W. O. Talbot, Fort Worth, Texas, Secretary.
Vermont.
The next meeting of the Vermont Board of Dental Examiners, for the examination of
candidates to practise in Vermont, will be held at the State-house, Montpelier, June 26-28,
191 6. — Harry F. Hamilton, Newport, Vt., Secretary.
West Virginia.
The next meeting of the West Virginia State Dental Association will be held at the
Kanawha Hotel, Charleston, W. Va., April 12-14, 1916. — J. W. Parsons, Huntington,
W. Va., Secretary.
Wisconsin.
The meeting of the Wisconsin State Board of Dental Examiners will be held at the Mar-
quette Dental College, Cor. 9th and Wells St., Milwaukee, Wis., June 14, 1916, commenc-
ing at nine o'clock. — F. A. Tate, Daniels Blk., Rice Lake, Wis., Secretary.
The next meeting of the Wisconsin State Dental Society will be held in Wausau, Wis.,
July 11-13, 1916. — ^Theo. L. Gilbertson, Secretary.
Digitized by
Google
FUTURE EVENTS 273
The Louisiana State Dental Society
LAKE /CHARLES
OVES V^IOMPANY
The Louisiana State Dental Society will hold their annual meeting in Lake Charles, one
of Louisiana's most picturesque cities, May 1-3, 191 6. An exceptionally unique, interesting
and instructive program has been arranged, and all visiting ethicAl dentists as might de
sire to attend are cordially invited. — ^J. Crimen Zeidler, Suite 11 29 Maison Blanche Bldg.,
New Orleans, La., Secretary.
FUTURE EVENTS
April 4-7, 1916. — Dental Manufacturers' Club, Chicago, 111. Meeting in the Banquet Hall,
Auditorium Hotel. — Chairman Exhibit Committee, A. C. Clark, Grand Crossing, Chicago,
April II, 1916. — Alabama Dental Association, Mobile, Ala. — J. A. Blue, Birmingham,
Ala., Secretary,
April 11-12, 191 6. — Odontological Society of Western Pennsylvania, Monongahela House,
Pittsburgh, Pa. — King S. Perry, 719 Jenkins Bldg., Pittsburgh, Secretary.
April 12-14, 19 1 6. — West Virginia State Dental Association, Kanawha Hotel, Charleston,
W. Va.— J. W. Parsons, Secretary.
April 13-15, 1916. — Michigan State Dental Society, Detroit, Michigan. — Clare G. Bates,
Secretary.
May 2-4, 191 6. — Iowa State Dental Society, Des Moines, la. — H. A. Elmql'ist, Des Moines,
la., Chairman of Exhibit.
May 3-5, 1916. — Massachusetts Dental Society, Boston, Mass. — A. H. St. C. Chase, Boston,
Mass., Secretary.
May 8-10, 191 6. — Ontario Dental Society, College Bldg., Toronto, Can.
May 9-10, 1916. — North Dakota State Dental Association. — A. Hallenberc, Fargo, No.
Dak., Chairman Exhibit Committee.
May 9-12, 1916. — ^Texas State Dental Association, Dallas, Tex. — W! O. Talbot, Fort Worth,
Tex., Secretary.
May 9-12, 191 6. — Illinois State Dental Society, Springfield, 111. — Henry L. Whipple,
Quincy, 111., Secretary.
May 11-13, 1916. — Dental Society of the State of New York, Hotel Ten Eyck, Albany, N. Y.
— A. P. Burkhart, 52 Genesee St., Albany, N. Y., Secretary.
May, 16-18, 1916. — Susquehanna Dental Association, Young Men's Hebrew Association
Bldg., Scranton, Pa. — Geo. C. Knox, 30 Dime Bank Bldg., Scranton, Pa., Recording
Secretary.
May 16-18, 1916. — Nebraska State Dental Society, Lincoln, Neb. — H. E. King, Omaha,
Neb., Secretary.
May 17-18, 1916. — Indiana State Dental Association, Claypool Hotel, Indianapolis. — A. R.
Ross, Lafayette, Secretary.
May i8r-20, 1916. — Lake Erie Dental Association, Hotel Bartlett, Cambridge Springs, Erie,
Pa. — J. F. Smith, Secretary.
June 1916. — Utah State Dental Society, Salt Lake City. — E. C. Fairweather, Salt Lake
City, Utah, Secretary.
June 1-3, 1916, — Northern Ohio Dental Association, Cleveland, O. — Clarence D. Peck,
Sandusky, O., Secretary.
June &-10, 1916. — Georgia State Dental Society, Macon, Ga. — M. M. Forbes, Candler
Bldg., Atlanta, Ga., Secretary.
Digitized by
Google
274 THE DENTAL DIGEST
June 13-15, 1916. — Connecticut State Dental Association, Hotel Griswold, New London,
Conn. — Elwyn R. Bryant, New Haven, Conn., Secrdary,
June 14, 1916. — South Carolina State Board of Dental Examiners will be held at Jefferson
Hotel, Columbia, S. C. — R. L. Spencer, Bennettsville, S. C, Secretary.
June 21, 1916. — Florida State Dental Society, Orlando, Fla. — M. C. Izlar, Corresponding
Secretary,
June 20-22, 1916. — New Hampshire Dental Society, Lake Sunapee, Zoo-Nipi Park Lodge,
Lisbon, N. H. — J. E. Collins, Chairman Exhibit Committee.
Juj.e 26, 1916. — North Carolina State Board of Dental Examiners, Battery Park Hotel,
Asheville, N. C. — F. L. Hunt, Asheville, Secretary.
June 27-29, 1916. — Pennsylvania State Dental Society, Pittsburgh, Pa. — Luther M.
Weaver, .103 Woodland Ave., Philadelphia, Pa., Secretary.
June 28-30, 1916. — North Carolina State Dental Society, Asheville, N. C. — R. M. Squires,
Wake Forest, N. C, Secretary.
June 29-July 30, 191 6. — Maine Board of Dental Examiners. — ^Harold L. Eicmons, Masonic
Bldg., Saco, Me., Secretary.
July 11-13, 1916. — South Carolina State Dental Association, Chick*s Springs, S. C. — ^Ernest
C. Dye, Greenville, S. C, Secretary.
July 11-13, 1916. — ^Wisconsin State Dental Society Meeting, Wausau. — ^Theodore L. Gil-
berton. Secretary.
July 12-15, 19 1 6. — New Jersey State Dental Society, Asbury Park, N. J. — ^John C. Forsyth.
Trenton, N. J., Secretary.
July 20-22, 19 16. — American Society of Orthodontists, Pittsburgh, Pa. Address communica-
tions to F. M. Casto, 520 Rose Bldg., Cleveland, O.
July 24, 1916. — Kentucky State Dental Society, Louisville Ky. — W. T. Farrar, 519 Starks
Bldg., Louisville, Secretary.
July 25-28, 1916. — National Dental Association, ist Regiment Armory, Louisville, Ky. —
Otto U. King, Huntington, Ind., Secretary.
October 9-15, 1916. — Arizona , Board of Dental Examiners, Phoenix, Ariz. — Eugene Mc-
Guire, 302 Noll Bldg., Phoenix, Secretary.
October i8r-20, 19 16. — ^Virginia State Dental Association, Richmond, Va. — C. B. Gotord,
Norfolk, Va., Corresponding Secretary.
January 23-25, 191 7. — American Institute of Dental Teachers, Philadelphia, Pa. — Abram
TiorFMAN, 529 Franklin St., Buffalo, N. Y., Secretary-Treasurer.
FOLLYGRAPHS
By Oscar Schleif
Consultation, operation.
A sweet tooth usually needs filling.
Love one another, but not another one.
It's the trying, not the doing, that counts.
There's many a gossip twixt the cup and the lip.
None can think time, but who has lived it.
Laugh if the world will borrow, weep if you get a loan.
What truth is stranger than that facts make fiction, and fiction cer-
tainly is a fact? — Physical Culture,
Digitized by
Google
The Dental Digest
GBORGB WOOD GLAPP, D.D.S., Editor
Published monthly by The Dentists' Supply Company, Candler Bldg.,
Times Square, 220 West 42d Street, New York, U. S. A., to whom all com-
munications relative to subscriptions, advertising, etc., should be addressed.
Subscription price, including postage, $1.00 per year to all parts of the
United States, Philippines, Guam, Cuba, Porto Rico, Mexico and Hawaiian
Islands. To Canada, $1.40. To all other countries, $1.75.
Articles intended for publication and correspondence regarding the same
should be addressed Editor Dental Digest, Candler Bldg., Times Square,
220 West 42d Street, New York, N. Y.
The editor and publishers are not responsible for the views of authors ex-
pressed in these pages.
Entered as Second Class Matter, at the Post-OflSce at New York City.
Under the Act of Congress, March 3, 1879.
Vol. XXI 1
MAY, 1916
No. 5
FOOD FOR DENTISTS*
By Watson W. Eldridge, M.D., New York
IVe recently learned, by practical experience, that wonderful benefit
results from a course of diet which does away with constipation. So
great has been my own benefit, that I'd like to have all understand the
relations between constipation and ill health, and then between correc-
tion of the trouble and joy in lixang, so I got Dr. Eldridge to prepare
these articles. Compare the story told in this one with some of your
own experiences. — Editor.
EFFECT OF CONSTIPATION ON THE NERVOUS SYSTEM AND THE MENTALITY
SECOND PAPER
Of all the abnormal conditions which afflict mankind by their oc-
currence in the himian body, probably none receives as little thoughtful
attention by the individual, as chronic constipation. One would sup-
pose, that, in view of the many lamentable conditions which are secondary
to, and superimposed on, this primary condition, the subject would re-
ceive more interested attention from the public in general. It is probably
due to ignorance of the consequences that leads most of us to neglect
the primarily simple condition of constipation until after the almost
disastrous results have become apparent.
* Continued from March Digest
Digitized by
Google
276 THE DENTAL DIGEST
I have shown in a previous article how easily the vicious cycle of
constipation may become established by being induced through sedentary
habits and I gave the prophylaxis of this condition.
SOME RESULTS OF CONSTIPATION
We now have to consider some of the results of a well established
chronic intestinal stasis, and in this paper only those relating to the
nervous system will be discussed. These run all the way from a simple
mental stupidity, to epilepsy and include loss of concentration, loss of
intellectual productive ability, various manifestations of hysteria, chorea
(of which St. Vitus' dance is one manifestation), neuritis, myalgia,
(pain in the muscles, of which intercostal neuralgia is a specimen),
sciatica, lumbago, and mental x)bsessions.
PROCESS, CONNECTING CAUSE AND RESULT
To the layman it is a far cry from constipation to epUepsy or lumbago
but let us see '^ the wheels go round," and observe the connection.
Beside the digestion produced by the enzymes of the stomach and
intestines there occurs in every man a digestion brought about by the
action of the bacteria which normally live and thrive in the digestive
tract. These bacteria are useful and necessary, inasmuch as they are
the only means the human organism possesses with which to produce
complete digestion. The digestive juices and enzymes excreted by the
various glands along the alimentary tract carry the digestive process to a
certain point only, and were it not for the presence of the bacteria in the
lower parts of the canal a large amount of nutritive material would be
wasted. It is even doubtful if life could be long sustained on the amount
of nutritive material absorbed from the products of the enzyme, diges-
tion alone. There are bacilli which convert starches into sugar, others
which emulsify fats, still others which transform albumin into peptones,
etc. The action of the microbes is, however, not limited to that; in
contradistinction to the gastric and intestinal enzymes, it goes much
farther in the splitting of the albuminous molecule and finally we have,
as a by-production, such toxic substances as the leucomaines, neurin,
and muscarin, and the ptomaines, cadaverin and putrescin, and many
others. As Combe says " — the microbes intervene actively in all the
digestive processes, but beside their undeniably useful role it is also un-
deniable that their action transforms the digestive canal even in the
normal state into a receptacle and constant laboratory of poisons."
Under normal conditions these poisons are taken care of by the body's
defense organization which consists of three separate systems, i. e., the
intestinal mucosa, the liver, and the various glands of internal secretion.
Digitized by
Google
FOOD FOR DENTISTS
277
These are all conceded to have an antitoxic function and the exercise of
this function prevents the intestinal toxins from producing their harmful
influence on the body organism, when these tvxins are produced in moderate
and normal amount only. In constipation, these toxic bodies are present
in excessive amounts. Not only is the toxic material which should have
been evacuated, retained, but this very retention provides a splendid
media m which the bacteria are stimulated to increased activity and
greater amounts of toxins are produced to be added to these already
present. When this process has developed to a certain point the anti-
He has become very irritable, is easily angered; and anything but a pleasant companion
to those associated with him in his work
toxic function of the intestinal lining, or mucosa, is overwhelmed and
the poisons are absorbed into the portal circulation. The liver then soon
becomes surcharged with the toxins and, after a certain enlargement due
to its effort to stem the tide of toxic material, its function in turn be-
comes weakened, and is defeated in the fight to prevent the passage
of these bodies, and they escape into the general circulation. The
antitoxic bodies in the bloodstream, which have been provided by the
glands of internal secretion (thyroid, suprarenals, etc.), now take up
the battle and for awhile the onward march of the toxins is arrested,
but sooner or later the antibodies are in their turn overwhelmed and the
individual then develops a true toxemia, cither acute or chronic, but
Digitized by
Google
278 THE DENTAL DIGEST
usually the latter, because the defensive system keeps up the fight and
succeeds in nine cases out of ten in preventing such a profound toxemia
that the patient becomes acutely ill.
Now the question arises as to what effect on the body organism is
produced by the presence in the blood stream of these toxic materials?
It has been shown that with their other detrimental activities they attack
not only the peripheral nerves but the nerve centres as well. The
sequence, severity, and character of the nervous symptomatology pro-
duced is directly dependent respectively, on the time the toxin attacks a
particular site, the virulence of the toxin itself, and the part of the
nervous system attacked. Affections of the peripheral nerves and nerve
terminations produce neuritis, muscular pains and perversions of the
sensory nerves, lumbago, and may induce skin lesion§ such as herjjes
zoster or "shingles*' (eruption along the course of a nerve). If the nerve
trunks are affected, sciatica, neuralgia, headaches, and their similitudes
may result; while more deep seated attacks, delivered at the nerve
centres, may produce paralyses of various sorts, pseudo-epilepsy, and
last but by no means least, mental disturbances may result and we see
apprehensions, obsessions, melancholia, loss of concentration, changes
in character and characteristics and psychic disorders too niunerous to
mention.
Let me quote you a typical case history of one of the so-called nervous
patients. He complains of not having felt well for some time, but
without any idea as to the cause of the trouble. He has grown pale
and listless. Appetite is poor and he has some headache and vertigo.
He may have had "sinking spells'' in which he actuaUy lost conscious-
ness or felt that he was going to. He has become very irritable and
sullen, is easily angered and his character may have changed from that
of an optimist to that of a pessimist. He has spells of melancholia, and
is troubled alternately with insomnia and lethargy. He may have had
no apparent symptoms of indigestion and will tell the physician his
stomach is all right. Close questioning may elicit the information that
he sometimes has spells of belching after meals and may pass quantities
of gas by rectum. He has reached the point where he can no longer do
a full day's work at the office, due to mental and physical exhaustion
which follows a comparatively small amount of work. He cannot con-
centrate his mind on the details of his business and he has become any-
thing but a pleasant companion to his family and those associated with
him in his work. He has probably been "constipated, off and on" for
several months or years but he "always takes a dose of salts" or some
Digitized by
Google
FOOD FOR DENTISTS
279
patent cathartic pill which **fixes it up all right" so that he has "no trouble
that way."
INCORRECT DIAGNOSIS
The diversity and multitude of symptoms enumerated by this com-
plaining and grouchy patient will give the physician much embarrassment
in forming a diagnosis. All the organic systems seem to be involved
except the digestive system, but it is this very multiplied and diversified
^$»*^'^f»0S Pf^^
The patient becomes actually ill
quantity of symptoms that should lead to an investigation of the digestive
tract. From the ignorant or too busy physician the patient will be told
that it is because he has a nervous constitution and will be advised not
to worry over it. It is just this sort of case that should receive the
closest attention. The stools, urine and stomach contents should
be careftdly examined. The physician should question the patient in
great detail so as to bring out history points which the patient may have
overlooked. Careful methods of examination will usually reveal con-
stipation to be the cause of these numerous and diverse symptoms and
the patient who supposed he would be afflicted the rest of his life, owing
to a "nervous constitution," will be far on the road toward relief.
To he continued
Digitized by
Google
280 THB DSNTAL DIGSST
WHY DISCARD THE TOOTH BRUSH? IT CAN BE EASILY
STERILIZED
By Ernest C. Dye, A.B., D.D.S., Greenville, S. C.
I suppose the best possible comment I can make on this article is that
after reading it I threw away all the tooth brushes in my family and
provided each member with a glass jar containing a little formalin.
Now, when I look at them, I feel that we are not unnecessarily and care-
lessly adding to the collection of germs already in our mouths. —
Editos.
"More than a million organisms have been found by bacteriologists
on the bristles of eight out of twelve tooth brushes, after they had been
once used. A number comparable with that found in sewage." This
statement so alarmed Dr. Bernard Feldman of N. J. that he advocates
discarding the tooth brush and giving us as its substitute ** The clean fore-
finger" which is a custom of semi-civilized and barbarous nations.
Is it not strange that Dr. Feldman should accept the statements
and experiments of these bacteriologists and then reject their remedy
without any consideration? Does his substitute better conditions?
Here follows the article from which the good Doctor quotes in his
"Menance of the Tooth Brush":—
"Recent experiments show that the great majority of tooth brushes
are in a disgusting stage of uncleanliness and so ladened with germs that
they are capable of spreading all sorts of disease. A brief ablution under
the tap or in a tumbler after using is all the cleansing the average tooth
brush ever receives and this is totally inadequate to render it reasonably
clean. In these experiments each of twelve sterile brushes was once
used, rinsed ten times in a tumbler of water and after standing twelve
hours all the bristles were removed with sterile forceps and examined for
germs. In eight out of twelve cases, more than a million organisms were
found, a number comparable with that found in sewage. The brushes
examined had been used by persons suffering from diseases of the teeth
and gimis. But four brushes used by persons with apparently healthy
mouths revealed almost as large a number of bacteria. Antiseptic pow-
ders and pastes are helpful in keeping brushes clean; but even they are
not sufficient.
" Experiments with seven such preparations showed that there ¥ras
an appreciable reduction in the number of organisms, with two others
there was practically no change, while with three others there was no
appreciable improvement.
" What makes the tooth brush particularly dangerous is that each
bristle point acts as an inoculating needle in carrying the microbes
Digitized by
Google
WHY DISCARD THS TOOTH BRUSH? 281
into the delicate membranes of the gums. As the brush should be used
at least twice a day, the gums get no chance to throw off one infection
before another is forced upon them. Dr. Ernest C. Dye of Greenville,
S. C, has invented a tooth brush with a hollow handle to meet these
difficulties. As soon as the brush has been used the bristle end is un-
screwed and stuck into the hollow handle. In the inside of the handle
a few drops of formaldehyde or some other powerful disinfectant are
kept. The fumes of the disinfectant sterilize the brush before the next
use. The same results may be obtained by keeping the ordinary tooth
brush in a wide necked bottle or fruit jar or any receptacle which can
hold the brush and a few drops of sterilizer. It must be air tight."
This article was written by Drs. Smale and Jones of London, England.
The former a dentist, the latter a bacteriologist in the employ of the
British Government. It first appeared in the Star Co. of London, copied
in this country by the New York Sunday American, Dec. 6, 1914, and
then by various papers throughout the United States and Canada.
Why discard the tooth brush? Let us ask the following questions.
Which would be the easier task, to teach the public to unlearn something
that it is accustomed to, and adopt a measure which is novel, or to
improve that which it now has? We rather think the latter plan more
feasible; therefore let us sterilize the tooth brush.
The medical profession has taught the necessity of precaution and
sanitation, and as the result of this we are "screening" against the in-
sidious mosquito and the house-fly. Civic authorities are most careful
in the inspection of "backyards" and places that breed germs and
disease. The "public drinking cup" is no longer tolerated, thus a
"consciousness" has been created which demands sanitation and
sterilization.
Drs. Smale and Jones have shown that the bristles of septic tooth
brushes act as inoculating needles, and that the germs found on them
will produce disease. They are the authors of the following article:
"Bacteriology of Tooth Brushes" {British Medical Journal 1910J:
"It is claimed by Smale and Jones that a tooth brush becomes septic
after one using. Each hair becomes an inoculating needle and the
person using it may be vaccinated with such germs as flourish on it. The
tooth brush therefore, as popularly used by the ignorant for many months;
may be the origin of pyorrhoea alveolaris, gastritis, and arthritis. The
prevalent tooth powders and tooth pastes as commonly used do not
render the tooth brush aseptic and even a solution of i in 20 carbolic
acid is not effectual. The authorities insist that all tooth brushes should
be boiled for five minutes before and after use. A new tooth brush can
be used each day. Those wishing for a more prolonged use of a tooth
Digitized by
Google
282 THE DENTAL DIGEST
brush can rinse the brush m tricresol (i per cent.) or allow it to stand
between use in formalin (lo per cent.).
"A tooth brush sterilizer can be made very readily with practically no
expense, even by the uninitiated.
**A11 that is needed is ^a wide necked bottle or a fruit jar/ place in
it a few drops of formaldehyde on cotton. Now the tooth brush, and
cork up air tight. In less than an hour's time all organisms will have
been killed. The brush is put into the sterilizer while it is damp.
" The writer has used such a sterilizer for three years, with good re-
sults; there is no injury to the handle, nor the bristles of the brush (as
claimed by Dr. Feldman, bone and celluloid handled brushes being
used). Neither is there any injury to the teeth nor the soft tissues.
The brush is held under the tap or rinsed in a glass of water before
using."
"An Aseptic Tooth Brush" (BriHsh Medical Journal 1913). "In
1910 Dr. D. W. Carmalt Jones and Mr. Herbert Smale read a joint
paper before the British Medical Association on some points of the
'Bacteriology of Tooth Brushes' in which they advocated the sterili-
zation of those articles, because it appeared to them that even in an in-
fected cavity such as the mouth, it was preferable that an instrument,
which is so used that it may scarify the gums, should not convey any
additional organisms directly into the wound. This appears to have
attracted some attention in America, and Dr. Carmalt Jones and Mr.
Smale informs us that an American dentist, Dr. Ernest C. Dye of Green-
ville, S. C, has devised a tooth brush, which is efficiently sterilized by
formalin vapor. It consists of a cylinder closed at one end by a hemi-
spherical cap, which contains wool soaked in formalin and kept in place
by wire gauze; the other end carries the brush which is screwed on for
use and after use is reversed and screwed inside the cylinder, where it is
exposed to the formalin vapor and rendered sterile. A more practical
modification, is they consider, the use of a long cylinder in which an
ordinary tooth brush is damp when put into the cylinder and all ordinary
mouth organisms are killed."
Further experiments were carried on by Dr. Wm. Litterer, A. M.,
Ph.C. M.D., Bacteriologist of Vanderbilt University, also for the State
of Tennessee (See May 1913 and May 1915 issues of Items of Interest).
The following were the results obtained: —
"The results of my experiments with your aseptic tooth brush are as
follows: —
"Experiments were made with full strength of formalin (formal-
dehyde gas 40 per cent, in water), I used the following bacteria to test
the germicidal power:
Digitized by
Google
WHY DISCARD TKfi TOOTH BRUSH? 283
"i. Streptococcus pyogenes.
"2. Staphylococcus pyogenes aureus.
"3. Bacillus typhosus.
"4. Pneumococcus.
"The following method was employed: —
The brush was rendered sterile by superheated steam (Auto Clave).
The brush was dipped into a pure culture of (i) Streptococcus pyogenes,
and was then returned to the receptacle to be acted upon by the formal-
dehyde gas. AJl of the above germs were treated in like manner and
in every instance double controls used. Both positive and negative
controls. The result was that complete sterilization was effective in
less than an hour's time. By drying the brush with the bacteria adhering
to it the effectiveness of the sterilization was greatly impaired. The
above results were obtained by using only the full strength formalin.
No dilutions were used. The question as to whether it would be too
irritating to the gums can be answered in the negative, if the brush was
rinsed in water before using. The method appears to be a very effective
and unique way of sterilizing a tooth brush and in my opinion should be
seriously considered by the dental profession."
It is to be hoped that this discussion of the unsanitary condition of
the tooth brush will be continued until the dental profession takes a
stand for the "sterilized tooth brush."
The immortal Miller a generation ago proved conclusively that
the mouth contains hosts of germs and that they are capable of pro-
ducing decay and disease. Will not this generation go a step farther
and demand that the instrument with which we brush our teeth and
gimis "shall be clean? "
Can the dental profession take the **next step" that Dr. Mayo speaks
of and leave the tooth brush in its present filthy condition?
REFERENCES
Items oflfUeresi, May 1913, May 1915.
Pittsburg Sunday Post, Dec. 6, 1914.
Scientific American, Mar. 13, 1915.
The Dental Cosmos, 191 1.
British Medical Journal, 19 13.
SotUh Carolina State Journal, 1913.
Oral Hygiene, Mar. 1915. "Menace of the Toothbrush."
The Literary Digest, 191 5.
Digitized by
Google
284 THE DENTAL DIGEST
DENTAL HYGIENISTS
By Edward F. Brown
Secretary, Dental Group, Advisory Council Committee on Child Hygiene,
New York City Health Department
A monograph of the Department of Health of the City of New York
states that it is safe to assume tliat not less than ninety per centum
(832,500) of school children of the city are in need ot dental treatment.
It may be said that this situation is due to imperfect tooth structure,
the causes of which lie partly at least in prenatal mal-hygiene, improper
feeding of children, lack of cleansing and neglect to prevent progressive
decay by early professional treatment.
The insidious character of tooth decay and disease is becoming
increasingly apparent from the scientific relationships being drawn be-
tween mal-hygiene and disease.
There are hardly enough licensed dentists to repair the dental ills
of the school population alone.
This situation, engaging the attention of school hygienists, has di-
rected attention to new means of attacking this problem.
It was apparent that little was to be expected from curative channels
in any effective programme of action. Prevention is the keynote of
modem health work. Inasmuch as the prophylactic principles of den-
tistry are defined, it was patent that the solution lay in this direction.
For some time Dr. Alfred C. Fones of Bridgeport had been success-
fully experimenting in the use of so-called ** dental hygienists" or speci-
ally trained women who give surface treatment to the teeth of school
children.
Last spring Dr. Philip Van Ingen, chairman of the Committee
on Child Hygiene of the Advisory Council of the Health Department
of New York, in conference with the Health Commissioner, appointed
the following members of the Advisory Council of the Department a
committee to study, report and recommend as to the desirability of
utilizing dental hygienists in New York: Dr. Herbert L. Wheeler,
Chairman, Dr. M. L. Rhein, Dr. Homer C. Croscup, Dr. Arthur H.
Merritt, Dr. Henry C. Ferris, and Edward F. Brown of the Bureau of
Welfare of School Children, Association for Improving the Condition
of the Poor, as Secretary.
The Committee held a number of meetings, and on February 8, 1916,
submitted the following unanimously:
"The sub-committee on dental hygienists held three meetings, at
which time the question of dental hygienists was thoroughly discussed.
Digitized by
Google
DENTAL HYGIENISTS 285
The committee now begs leave respectfully to report that a trial of
surface cleansing of teeth of school children with accompanying instruc-
tion in oral hygiene be commenced at the earliest possible moment in
one or more centres, preferably public schools, provided that the work
be done by specially and adequately trained persons and under the'
supervision of competent directors."
On February 17, 19 16, the whole Committee on Child Hygiene of
the Advisory Council ratified the report and reconunendations of the
sub-committee.
Dr. Haven Emerson, Commissioner of Health, has evidenced the
keenest interest in this work and it appears probable that at an early
date some nurses will be assigned to this work.
At one time there appeared to be some question as to the legality
of employing dental hygienists. The question was submitted to the
Corporation Counsel by the Health Commissioner who reported that
there is nothing in the dental law to prevent the use of dental hygienists.
In order, however, to avoid any possibility of untrained persons enter-
ing upon the work without proper safeguards to prevent fraud, ineffici-
ency and exploitation, the legislature passed a bill (Senate Bill No. 391)
which has just been signed by Governor Whitman, the provisions of
which on this subject are as follows:
"Any dental dispensary or infirmary legally incorporated and reg-
istered by the regents, and maintaining a proper standard and equip-
ment may establish for women students a course of study in oral hygiene.
All such students upon entrance shall present evidence of attendance of
one year in high schools and may be graduated in one year as dental
hygienists, upon complying with the preliminary requirements to ex-
amination by the board, which are:
A. A fee of five dollars.
B. Evidence that they are at least twenty years of age and of good
moral character.
C. That they have complied with and fulfilled the preliminary and
professional requirements and the requirements of the statute.
After having satisfactorily passed such examination they shall be
registered and licensed as dental hygienists by the regents under such
rules as the regents shall prescribe.
Any licensed dentist, public institution or school authorities may
employ such licensed and registered dental hygienists. Such dental
hygienists may remove lime deposits, accretions and stains from the
exposed surfaces of the teeth, but shall not perform any other operation
on the teeth or tissues of the mouth. They may operate in the office of
any licensed dentist, or in any public institution or in the schools, under
Digitized by
Google
286
TH£ DENTAL DIGEST
the general direction or supervision of a licensed dentist, but nothing
herein shall be construed as authorizing any dental hygienist perform-
ing any operation in the mouth without supervision. The regents may
revoke the license of any licensed dentist who shall permit any dental
hygienist operating under his supervision to perform any operation other
than that permitted under the provisions of this section."
This law follows the enactment of similar ones in Massachusetts
and Connecticut. With these progressive steps taken, it is to be hoped
that through prevention we will preclude the possibility of another
generation of children growing up, 90 per cent, of whom will be exposed
to the havoc wrought by diseased and rotting teeth.
OUR ANNUAL GOOD FELLOWSHIP DINNER, 1916
This is the picture of the Annual Good Fellowship Dinner given at
the end of the Clinic and Exhibit of the Marquette Alumni meeting
each year. We had some stunts on the stage and as we drank our
famous beer we sang our college songs and then flew away like the
swallows to meet again next year. Dr. Albert Frackelton.
Digitized by
Google
THE CLINICS AT THB NATIONAL MEETING 287
THE CLINICS AT THE NATIONAL MEETING
For many years the meetings of the National Dental Association were
conducted without clinics. It was deemed that the dignity of that body
would be lowered by demonstrations by mechanics to show how to do
things. The entire time of the sessions was given over to scientific and
near-scientific papers and their discussion.
Now the success of all dental meetings, including the National, is
measured by the number and character of its clinics as much as, or even
more than by the papers that are read.
Hence a foreword anent the clinical programme for the meeting of the
National at Louisville in July, will not be without interest.
In the first place, the fact that Dr. Wm. H. G. Logan of Chicago is
National Chairman of Clinics gives assurance that this feature will be of
the highest order of excellence and that the plan of its conduct will be an
example of organization such as he alone is master of.
Though the details are not yet complete, the following may be given
out as the frame work of the plan which has practically been decided
upon.
On Wednesday afternoon from 1 130 to 5, at Keith's Theater (seating
capacity 3,000, ventilated with washed and refrigerated air — ^important
items in July) there will be given fifteen-minute lectures illustrated with
stereopticon and moving pictures, on subjects of the most vital interest
to dental practitioners of to-day, and by men specially selected for their
knowledge and their ability to impart it in effective concentrated fifteen-
minute doses.
Ftiday morning at 9:30, and until 12:30, a sectional Progressive
Clinic will be conducted in the balcony of the Armory which will present
some new and novel features in the way of a progressive clinic. The
arrangements will be such that everybody will see every clinic without
discomfort or inconvenience.
These clinics are to be given by dentists residing in the district of the
National in which Louisville is located and comprises the States of Michi-
gan, Indiana, Kentucky and Tennessee.
There will also be surgical clinics by men of national reputation, at
the City Hospital.
Altogether the clinical programme offered at the 1916 meeting of the
National Dental Association will be worth a Sabbath day's journey with
part of Saturday and Monday if necessary, to come to Louisville in July
to see, even if you saw or heard nothing else.
Digitized by
Google
288 THB DBNTAL DIGEST
WHY ARE THERE TWO DENTAL PROTECTIVE ASSOCIATIONS?
Since the recent publication of the report of the Dental Protective
Association of the United States, the question has been asked many
times: "Why are there two dental protective organizations? "
When the Dental Protective Association entered into its agreement
with Dr. Taggart, by the terms of which Dr. Taggart agreed to license
its members to use the process disclosed in his patents, for the sum of
$15, and by which it agreed not to participate in, or contribute to, the
defense of any dentist against whom Dr. Taggart might bring suit for
infringement of his patents, there was brought about in the dental world
a condition which is, in itself, an answer to the above question.
We quote from the article published in various dental journals,
which is dated January 3, 191 6, which, among other things, sets forth
the status of the members of the Dentral Protective Association with
reference to the pending Taggart litigation:
"The question is frequently asked: Where does the individual
stand, with reference to the pending Taggart litigation, who is a member
of this Association in good standing and who did not accept the terms of
the agreement with Dr. Taggart before the time limit expired? In reply
to this important question we will say that every member was notified
individually and through the dental journals, not once but several
times, of the opportunity afforded by the terms of the agreement; and
those who did not accept forfeited their rights to protection from this
source, by this association. They are hereby notified that they may either
settle direct with Dr. Taggart or MAKE WHATEVER OTHER AR-
RANGEMENTS THEY SEE FIT TO PROTECT THEMSELVES
FROM THE TAGGART PATENTS."
The last sentence in the above quoted paragraph is the main reason
and answer for the second dental protective organization.
After the agreement with Dr. Taggart was effected by the Dental
Protective Association, and after the dentists of the country had been
given a suitable opportunity to avail themselves of its privileges, if they
so desired, and the time in which they might do so had elapsed. Dr.
Taggart commenced a campaign to coUect money.
Using roimd figures, about 10 per cent, of the dentists of the country
availed themselves of the opportunity afforded by the Dental Protective
Association, and the other 90 per cent, did not. There were just two
things which this 90 per cent, might do: the one, to submit and pay;
the other, to organize and test out the validity of the Taggart patents.
A group of Chicago Dentists decided to adopt the latter course, and
Digitized by V:iOOQIC
WHY ARE TH£R£ TWO DBNTAL PROTECTIVE ASSOCIATIONS? 289
at a meeting held at the Grand Pacific Hotel in June, of 1914, The
Dentists' Mutual Protective Alliance came into being.
The purpose of the Dentists' Mutual Protective Alliance is the pro-
tection of its members against process patent exploitation. While the
immediate work in hand is the Taggart litigation, yet its real purpose
is to be in the field, big and strong and ready to defend the dental pro-
fession against all those who have unadjudicated process patents to
exploit. This position is assured by the provisions of its By-laws, which
reads as follows: "No process patent shall be compromised."
Immediately after organization,, the management of the Dentists'
Mutual Protective Alliance took up the work of testing the validity of
the Taggart patents. In this connection it may not be understood by
all dentists just how or just what must be proven to invalidate a patent.
When a patent is granted by the United States Patent Office, it is as-
sumed that whatever is claimed therein, is new or novel. If it can be
proven beyond a reasonable doubt that whatever is claimed therein as
new or novel was in use more than two years prior to the date of the
patent, the patent falls.
The work of the Alliance has been to show that the processes dis-
closed in Dr. Taggart's patents, were in use more than two years prior to
the date of his patents, or prior to 1905. To this end the case has been*
twenty days in Court; the attorneys of the Alliance have visited most
of the states of the Union from Pennsylvania to Arizona, getting together
evidence; while the trial was in progress last June, they had more than
120 people in attendance, either directly or indirectly, as witnesses.
The triaJ lasted weU into July, when it became apparent to the
Court that the end was a long way off, and he, therefore, adjourned the
case until the Fall Term, subject to call. During the winter there
have been several days of argument on motions, and the like, and it is
probable that the main case will be caJled at an early date.
The present case is what is known as a test case, and an Appellate
Court decision in the pending litigation will be, in effect, binding through-
out the^United States. Should Dr. Taggart be successful in this litigation,
the question to those who do not have Taggart licenses, will be: "How
much do you owe Dr. Taggart?" On the other hand, if the Alliance is
successful, the Taggart patents fall.
This is said to be the largest and most important piece of dental patent
litigation that was ever before a Federal Court for adjudication. The
Dentists' Mutual Protective Alliance is the only organization in the
field in a position to take the part of 90 per cent, of the dentists of the
country in that litigation. This would seem to be a sufficient reason
for the second dental organization.
Digitized by
Google
290 TH£ DENTAL DIGEST
CLOSED MOUTH IMPRESSIONS*
By Samuel G. Supplee, New York, N. Y.
FOURTH paper
proper use of the bunsen burner
A Bunsen flame presents three distinct temperatures.
The tip of the flame is the hottest part; and if it is brought directly
into contact with the modelling compound, it will cause the surface to
sizzle or bubble.
The middle of the flame is what might be termed medium warm;
compound passed a little way into the side of the flame will be heated
slowly, and to a uniform consistency by moving it back and forth.
The base of the flame is the coolest part. The material can be passed
into this part of the flame more slowly without danger of bubbles and
blisters, and the heat will be transmitted to a greater depth without
causing the surface to flow.
Each one of these three distinct temperatures, properly applied, is
of great value to the operator.
THE proper size OF FLAME
A small Bunsen like the one attached to the Supplee outfit illustrated
in the March issue should be used.
The Supplee Bimsen has a little cock attached to the frame to regulate
the exact height of the flame.
The flame should be a clear blue, and should not be over one inch
from the mouth of the burner to the tip of the flame.
A flame of greater volume will not be so easily controlled. Many
impressions are spoiled when the attempt is made to transform them
from an impression with the mouth open to one with the mouth closed,
by using too large a flame and by permitting the flame to glance so that
it will heat a portion of the impression that it is desirable not to change.
PREVENTING THE COMPOUND ADHERING TO THE FINGERS
As compound cools from the surface and is exceedingly sticky when
in a flowing state, the Supplee heating apparatus is so designed that the
hot and cold water pans are close together, and a glass spatula is furnished
for raising the compound from the bottom of the heater pan when in a
semi-flowing state.
It is vital that the spatula with the compound be quickly immersed
•This article began in the January, 191 6, number
Digitized by
Google
CLOSED MOUTH IMPRESSIONS 291
in cold water and the fingers must be wet before an attempt is made
to remove the compound from the spatula. Otherwise, one will have
considerable trouble with the material sticking to the fingers.
If the water in which the compound is heated is hotter than 170 de-
grees, the compound will become very sticky and will adhere to fingers
even if they are wet. It is well to cool it before proceeding, as this will
save time.
This stickiness can be avoided by letting the compound lie in water
at 160** for five or ten minutes.
In taking compound from hot water always reach to the bottom of
the pan and scoop up the compound on the end of the glass spatula.
Then with two or three deft turns of the spatula, lift out enough com-
pound for an impression and give it a quick dip into the cold water pan
before attempting to remove the compound from the spatula with wet
fingers.
The thin film of hardened surface compound will not be sticky. By
slightly kneading the material, this film is dissolved and will become of
the same consistency as the rest of the mass.
Avoid touching compound that has been heated over the flame with
either dry or wet fingers. Dip it in water first, but avoid permitting the
impression tray to come in contact with the hot water, as aluminum
absorbs the heat rapidly.
An impression tray that has lain in water of 165 degrees cannot be
inserted in the average mouth without burning the patient or causing
discomfort. It will also retard the setting of the compound.
EUMINATING THE ROCKING OF AN UPPER IMPRESSION
During the manipulation of compound, one may cause an impression
to rock.
There are a number of ways to eliminate this condition. The method
to be employed must be determined by the case in hand.
Where the ridge is hard and the muscular attachments are definite
in their action, heat the surface of the water to about 170 or 175 degrees.
Fill a Spooner self-fillicfg syringe with hot water two or three times and
empty it so as to thoroughly heat the bulb and metal part. Then fill
it with hot water and suspend the impression over the pan heels down
and force the water to strike over the centre of the palatal portion and
flow to the bottom of the ridge in front and off at both sides for half a
minute. Quickly pass into the mouth and gently but firmly place up to
position by bringing pressure with the index finger under the centre of the
tray and have the patient make the face movements. Hold firm until
thoroughly set.
Digitized by V:iOOQIC —
292 THS DENTAL DIGEST
If the rock should develop after you have established the biting
block, or the plane of occlusion, follow the same technique as already
described and place the tray in the mouth and have the patient bite it
up to place with a gentle but firm pressure, and make face movements.
Before doing this adjusting, one must be sure that the occlusal sur-
face of the compound biting block is flat and smooth in the molar and
bicuspid region. If the opposing cusps are embedded in it to a depth of
even half the thickness of a cardboard, it will interfere with the proper
correction of the impression.
HOW COMPOUND CAN BE SPOILED
There are many ways in which compound can be six)iled, a few of
which are as follows:
First, by over-heating. As soon as compound has lain in boiling
water for a few minutes, it will not only lose its quick setting qualities,
but when it does set, it will not be hard.
If left lying in water of over i8o degrees for half an hour or more, it
will not set quickly or nearly so hard.
Compound should never be used a second time.
When a cast has been poured into a compound impression, the plaster
seems to extract or neutralize some of its qualities so that it not only sets
slower, but is more difficult to work and will not secure the best results.
Many impressions are failures for this reason alone. They are easily
bent and will be changed materially by the lips when taking them out
of the mouth.
After compound has lain in water of 120 degrees or more for over five
hours, it will lose many of its qualities for quick accurate work.
GLOSSING CASTS
By using a ver\^ thin solution of model separating varnish or water-
glass and applying it over the surface quickly with a brush, you will
give to the cast a smooth surface which is conducive to a better finish
on the completed denture.
Last, but not least, ice-water or cold air should always be used in
cooling compound before taking it out of the mouth, in order that there
may be no changes where the margins are thin.
Aid in Soldering. — Use the base of an inverted gas mantel as a
soldering base. Place it on your asbestos soldering block. The flame
will have easy access to all parts of investment, and you will lessen your
troubles to nil. — Nils Juell, D.D.S., Minneapolis, Minn.
Digitized by
Google
CAST-CUSP GOLD CROWN
295
CAST-CUSP GOLD CROWN
By a. Bruce Coffin, D.D.S., Apache, Okla.
Prepare root in the usual manner, leaving the stump in the shape of
a cone or at least with parallel sides; grind off occlusal surface so that
there will be a space of at least i§ mm. between it and the occluding
teeth at all positions of the mandible. Make band in the form of a cone
after the method of Dr, Prothero which, briefly, is as follows:
Take card-board 5 inches by 2^ inches and near the bottom of the
left margin, make another mark (b). Using the lower mark (a) as a
centre make the arc of a circle starting from the upper mark (b). To
mark gold plate for cutting band, take wire root measurement, cut and
bend to conform to the curve of the arc on card and mark the length
from (b) on the arc. Place gold plate on the card with the left margin
of the gold on the left margin of the card and the lower edge of the plate
(if it be a rectangular piece), bisecting the arc at the mark indicating the
length of the wire measurement (c). Now with the gold plate held firmly
in place mark the arc (c) on the plate; with a straight edge bisecting the
(a) and (c) mark end of band; with radius extended the width you wish
the band mark second arc on plate (d e).
Fit band to root, contour and set band in place on stump. See that
the end of band does not interfere with occlusion. Warm inlay wax
and place in occlusal portion of band and have patient bite firmly to-
gether. Have patient bite in lateral occlusion and by any possible
movement of the mandible bite down wax. Tack wax to band with
Digitized by
Google
294 THB DENTAL DIGEST
hot instrument at several places on the periphery of band but do not
touch occlusal portion of wax. Cool wax, remove band with wax in
place and pour band full of investment compound. You may now
dismiss patient.
When investment is hard, carve occlusal portion of crown in the wax.
Do not add wax to the occlusal portion but, of course, wax may be cut
away wherever necessary, leaving the original occlusal wax where you
wish the crown to come in contact with the occluding tooth. In adding
wax, if it becomes necessary, use a color contrasting with the original so
that if the occlusion has been interfered with it may be detected. Cast
by usual method.
By this method no articulator is needed. It is not necessary to
refit the carved wax crown on the tooth — ^if indeed it were possible to
do so without distorting the wax, provided the band was properly fitted.
By filling the band with investment compound the wax is prevented from
being pushed farther into the band thus interfering with the occlusion
and also preventing the cast crown from going to place.
By this method, with acquired skill, a perfect anatomical crown
may be made quickly and easily.
PERFECT ARTICULATION IN POSTERIOR BRID6EW0RK BT
THE USE OF TRUBYTE MOLAR BLOCKS
R. D. Pray, D.D.S., Sheridan, Oregon
The ideal place for restorations of this character are where the
teeth on the same side, both upper and lower, are to be replaced. Any
restoration back of the cuspids can be made with the molar blocks.
If one or more teeth are to be used, simply cut off the teeth with a sep-
arating disk, saving the remaining teeth for some future case. In
using the blocks, for work of this character, you will turn out bridge-
work that is pleasing to the eye and anatomically correct in principle.
The time used and the expense will be less than if you had used all
gold, and the final result will astonish you. For illustration take two
molar blocks, articulate them between the fingers, then look ahead.and
figure how you can obtain that result on your next case.
There is nothing difficult about using the molar blocks and I believe
that the idea has great possibilities for originality in the operator's
technique, and the range of use will depend entirely upon the individual's
mechanical ability.
Digitized by V:iOOQIC
PERFECT ARTICULATION IN POSTERIOR BRIDGEWORK 295
METHOD OF PROCEDURE
Make your abutments in the regular manner, take your bite and im-
pression and mount on an anatomical articulator. Determine size and
shade of blocks to be used. Then grind the ends of block imtil they fit
snugly between abutments, taking care that the articulation is perfect.
Now remove blocks and with a small stone cut out the undercuts in the
diatoric blocks, then grind the ends that lie next to each abutment at
about a 45 degree bevel — which will allow for the strength of backing
attachment to crowns. Now soften your inlay wax and press into the
back of block, taking care that the wax goes well up into the holes, shape
up wax flush with edge of block, or for added strength let wax extend a
trifle below edge. Invest wax impression and cast with your scrap gold.
This backing can be cast in one piece or in sections-as you like — ^possibly
the casting in sections would be easier and more accurate. At the
final soldering they will be all joined in one piece.
After the casting operation, smooth the backing until it will go into
place easily, then wax all parts into their correct positions on the arti-
culator, remove blocks, invest the case and solder. Polish the work,
cement on backings and you have a beautifully finished piece of bridge-
work with perfect articulation.
When you cut a tooth off the blocks, before laying it aside for future
use, make a die and counter die of it so that you can carry out the ana-
tomical feature on the crown abutment that is to take its place.
In using the upper and lower blocks, it will not be necessary to do
much grinding as the teeth will be found to articulate perfectly. And
in cases where the blocks are to articulate with the natural teeth, you
will find that they will articulate easier than any tooth that can be
used, and the natural appearance of the case, when finished, will more
than compensate you for the care taken.
Dissolvable Impression Plaster. — F. Duijvensz recommends a
mixture of two parts of potato flour and ten parts of plaster of Paris to
make a dissolvable impression plaster. The potato flour must be very
dry. The mix is made with cold water to which a pinch of table salt is
added. After having been assembled, the impression is coated with a
solution of one part of potassium or sodium silicate (waterglass) in three
parts of water, and the cast is poured. After the cast has set, the im-
pression is dissolved away in boiling water. — British Journal of Dental
Science.
Digitized by
Google
{nNE/(/5viLDING
The only business which is good busi-
ness is that business which tends to build
the man while the man is building the
business.— **A^ep/i//ie"—Ne*r. Dent. Jour,
FIFTY-FIFTY
W. F. Davis, D.M.D., New York City
Two or three weeks ago I felt that I needed a little rest from business,
and decided that I would visit one of my old classmates, who soon after
his graduation had located in a town a couple of hundred miles north
of me. I had never heard of his death or removal from the original
location and therefore decided that he must have remained there. I
thought I would take a chance anyhow, as it was a pleasant section of
country and I had never visited it.
Dave Brown was one of the brightest, most capable and most popular
members of the class. He was ambitious, full of energy and everybody
prophesied a briUiant future for him.
On reaching my destination I readily found Dave's office. It was
centrally located, over the post-office. As I entered the office Dave
came out from his little laboratory and met me with a questioning "what
can-I-do-for-you" look that changed almost instantly to recogm'tion.
"Great Heavens, Tom! You dear old fellow! I can't tell you how
glad I am to see you. Sit right down and tell me all about yourself,
and the rest of the boys. IVe been sort of side-tracked up here and
haven't kept in touch with the rest of the class. My, but I'm glad to
see you."
We gossiped for an hour or so about old times. I told Dave about
myself, where I was located, my business, my family, and my plans for
the future. Then I said: "Tell me all about yourself, Dave. How has
the world been treating you?"
"Tom, I think a kind Providence sent you to me, to-day. I can
unburden my heart to you as I cannot to any other living person. Tom,
I'm scared. Of course, you don't know why or what about. I'll tell
you. I was 63 years of age last month. I've been practising here 42
years. I am doing work now for the grandchildren of some of my first
patients. You know when I graduated, I was considered the best oper-
ator in the class. I was fond .of operating and proud of my ability. I
Digitized by
Google
PIPTY-PIPTY
297
was also good in what we then called 'mechanicar dentistry. It's
'prosthetic' now. When I located here I was well equipped to do good
work. I was fully determined to do nothing but good work and I have
lived up to that determination. I have always given good, conscientious
service. Every week I see in the mouths of some of my old patients,
gold fillings that I put there fifteen and twenty years ago, and that are
still in good condition. I have given the community the very best that
was in me. They know it, and appreciate it. The people here in A —
"I'm on the down grade. I'm slipping. My hair is almost white"
like ilie. They respect me. They trust me and they know they can
depend on what I tell them. They ask my advice about many other
matters than dentistry. I am really a popular citizen. The voters
elect me to some minor town office occasionaUy, such as school trustee,
board of health, and such like. I am quite in demand as an after dinner
speaker. I don't know that I have an enemy in town. I sometimes
wish I did have some enemies. It would at least show that I had some
aggressiveness."
I remarked that what he had told me thus far would seem to indicate
that he was ideally located. "It looks so, doesn't it, Tom? I'll show
you some of the other side. I'm on the down grade. I'm slipping. My
hair is almost white. My eyes are failing me and my hand is a little
Digitized by
Google —
296 THE DENTAL DIGEST
unsteady. They caU me 'Old Dr. Brown.' And the other day I over-
heard one lady remark to another. 'Don't you think Dr. Brown is
failing?' I am failing. I am growing old. When I think of the future
I am frightened. I know what you are thinking. You think I had a
good practice for all these years and that I have saved some every year
and that it is time for me to retire from practice and spend the rest of
my life in ease and comfort. That is as it should be. Every dentist
should be able to retire at 60. I know it now. I didn't forty years
ago, and the knowledge only recently came to me and it has come too
late. When I located here the conditions were unusually favorable,
and I had a good practice from the very start It increased until it
was as good as any practice in the coimtry. Naturally, I was pleased
at my success. I married and raised a family. We lived as well as
any family of moderate means in the town. I was very well satisfied
with myself. My ambition died an unnatural death. As my children
grew older and my expenses increased, my income did not. My practice
stood still. It was at flood tide, soon to ebb. Sometimes the thought
came to me that my income from it was not as large as it should be,
considering the amount of work I did. I know now why I didn't get
more money out of my practice. I was careless in charging and care-
less in coUecting. Do you remember how Professor B — used to solemnly
warn us students against 'commercializing the profession.' It was a
nice, mouth-filling expression, and I really thought it was valuable
advice. I tried to foUow it, and because I followed it I am a poor man
to-day. I have lost thousands of dollars through failure to charge a
proper fee, and sometimes because I failed to charge at all. I have lost
other thousands through loose methods of collection. I was afraid to
offend people by sending them bills too promptly. I sent bills once in
six months — ^many times once a year. People died, moved away, went
into bankruptcy, and I lost. If I had been in the habit of sending
biUs once in 60 days, or certainly every quarter, I should have collected
most of this money."
"But, Dave," I interrupted: "Why did you allow yourself to drift
along in this manner so long? When you first saw your practice decreas-
ing, why didn't you find out the reason, and get a little system started
to stop any further loss?"
"It was that same fallacy about 'Commercializing the profession.'
I thought it would not be dignified or professional. And I really did
not know just what to do. I have got most of my ideas about 'Business
in Dentistry' from my most dangerous competitor. He located here
about two years ago. He was right out of college, just as I was when
I came here. He is a first-class workman, a nice fellow, dignified, but
Digitized by V:iOOQIC
PIPTY-PIPTY
299
always pleasant We are very good friends, and always have been. He
has secured a good many of my old patients, but I know in almost every
case he has advised them to remain with me, and has only taken them
because they had lost confidence in me on account of my growing old,
and would have gone elsewhere if he did not take them. He always
speaks highly of me and of my work. I drop into his office quite often
and he comes to mine, and we have compared methods and systems.
He has some advanced ideas about business in dentistry, and says mine
are all wrong. He has the most complete and accurate system of charg-
ing. Every operation is charged on the basis of the time taken and the
'V^ 'I .'i/Jti^t fif-^l^
"I'm starting in on the theory that dentistry should be on a 50-50 basis — fifty professional,
and fifty business"
material used. He sends bills the first of every month, and expects to
have them paid promptly. Think of that! If I should do such a thing
my old patients would think I had lost my mind. I told him so, and
sprung that warning about 'Commercializing the profession.' 'That's
nine tenths bunk,' said he. 'I have as much regard for my profession
as any man, and I wouldn't do anything to disgrace it, but I am not in
dentistry strictly for my health. It's my business, and it must give me
a living. I give my patients good work, the best service in my power to
give. I charge them a reasonable fee for this service, and I expect them
to pay, and pay promptly. Why not? My butcher, and my grocery-
man, and my plumber expect their bills paid promptly the first of every
month. Why shouldn't mine be paid as often and as promptly? You're
Digitized by
Google
300 THE DENTAL DIGEST
all wrong, Dr. Brown. You started wrong and I suppose it is too late
for you to make a radical change. I'm starting in on the theory that
dentistry should be on a '50-50' basis — fifty professional and fifty busi-
ness. It must not only give me a living for the present, but enable me
to put aside something for the future. If it won't do that, I'll quit and
take up something that will.' That was a presentation of dentistry
from a new point of view, and most especially the '50-50' idea. It's the
right point of view, but it has come to me too late. Don't you see that
it has, Tom?"
I was puzzled to know what to say, what advice to give, but sug-
gested that there must be some way out.
"If there is, I have failed to discover it, and I have racked my brains
to find one," said Dave. "It's useless to raise my prices after all these
years. I'd be afraid to do it. I've got to keep up my present mode of
living. Any visible attempts at economy would be business suicide.
Rats desert a sinking ship, you know. I own a house but it is only p)artly
paid for. I could get along with a smaller, cheaper one, but there you
are again confessing failure. I dare not risk it. I know my friends
think I am prosperous. They think I don't care to have very much
practice; that I am pretty nearly ready to retire. I ought to be, but
I can't, Tom, I can't. Can't you understand why I said I was 'scared'.
It is pretty nearly a tragedy. Why didn't somebody tell me about
that '50-50' idea forty years ago? It would have made just the difference
between prosperity and failure."
I had to leave Dave, but I have had a heavy heart whenever I have
thought of him and his future. I wonder if there are not many others
whose future looks as dark as his, all because they were not taught that
dentistry was a business as well as a profession?
THE NECESSITY FOR KEEPING COMPLETE RECORDS
By C. Charles Clark, D.D.S., Kansas City, Mo.
One of the most difficult things for the ordinary professional man
to do, is to get his debit and credit records in any sort of shape, and
some have not the necessary help to do this many times unpleasant work.
When one gets through with a difficult operation, it is easy to allow the
making of a record to go over until the next day, so any innovation looking
toward simplifying the method of keeping these records will be appre-
ciated.
There are several reasons why you should keep your records so that
Digitized by
Google
THE NECESSITY FOR KEEPING COMPLETE RECORDS 301
they can be understood, not only by you, but by others, in case there
arises a dispute as to what was done and what was not done by you.
For instance, it had always been the habit of the writer, until he
learned better, to arbitrate his accounts, on any pretext whatever made
by the patient, but he found he made no friends by that course of proce-
dure, but on the contrary people considered him easy, so he sought a
better way, and found that there were a number of systems, the most
common, being one with pictures of teeth. It is true that you can
mark black spots on the teeth, but that is in addition to the written
record of the charges, and serves no additional purpose.
The record should be so written that when read, it forms a picture
in the mind of the patient at once, without further explanation. The
teeth pictures occupy a great deal of space, which could be used to
better advantage.
Did it ever occur to you that in other dignified callings, they do
not use characters to represent the sales? However, they may have
some particular code, which is used as a simplification of their written
record, which can be explained so that when a disputed account is
brought into court, there can be no question of its meaning.
The writer has noted three kinds of accounts, cash, book and notes.
Cash is the ideal business, and one that exists in a very few cases; open
accoimts, the delusion and snare that has caused many a professional
man to end his days in penury and want; and the negotiable note, or
contract, which will permit you to raise money before its maturity, if you
desire.
When it comes to collection of your outstanding indebtedness, a
third party can do better for you as a usual thing, and the reason for
this is that they have a range of emotions to play on that you can't even
mention, and they seldom hesitate to use everything at their command
to turn the debits into cash.
And I want to repeat that you should have an understanding with
your patient at the earliest possible moment regarding your fees. At
that time he is seeking your services, so then is the most opportune
moment to arrange for future payment.
When your patient asks you what your work will come to, make him
an estimate, computed on whatever system you may use; most of us
have a hit or miss system; we claim to charge so much per hour, or per-
haps so much a tooth, but I find that some work I am doing at less than
five dollars per hour, and other work at as high as twenty-five dollars per
hour, so I am trying to see where I can mend this.
It IS a fact that for some classes of work the patient will pay more than
for others, because, as between precious stones, more is paid for the dia-
Digitized by
Google
302 THE DENTAL DIOBST
mond than for the opal, so it is between different fonns of service. The
pictures of the values are different in the patient's mind, and it is hard
to change these pictures.
However, we should study and strive by every honorable means to
arrive at a correct system, so that we may charge fairly.
On my ledger, I especially note the manner of payment, when, where
, and how to be made, and I find it a good plan.
It is well to know what your patient can pay, for obviously you
wouldn't try to talk a laborer's child into a thousand dollar case of ortho-
dontia, and yet you would not hesitate to tell a prosperous business
man that he should spend a thousand dollars on his child and proceed
to show him why.
"Yield unto Caesar that which is Caesar's" but unto me that which
is mine, is a lesson to all of us. And say what you will, you and I often
work for supposedly deserving people for less than we should and these
people could pay as well as some others of whom we ask more.
I have heard it said that a professional man's work was worth in
proportion to what his patients were able to pay. And in a great
many instances you will lose patients unless you charge them well. A
fee that keeps you always laboring, and only permits you to eke out an
existence, will never permit you or any of those dependent on you, to
get the rubber tire habit.
I presume that there are a great many who have good records, but
if you have not you are cheating yourself and casting a certain amount of
discredit upon the profession of which we want you to be an honorable
member.
621 CoiiMERCE Bldg.
To Sav'e Time During the Use of Silicate Cebients. — ^The ma-
jority of silicate fillings are placed in the upper teeth while the rubber-dam
is in position. To save time the dam has been drawn down and tied with
a ligature and then cut off. This sometimes strains the rubber so that
leakage occurs, and when finishing it is sometimes annoying to control the
loose margins, and there is also danger of moistening the filling. As a
substitute for this procedure the following has proved valuable: During
the hardening of the cement, turn up the lower edge of the dam and pin it
securely to the upper edge on both sides. The patient can now talk,
expectorate, etc., as though the dam were not in position, and even other
work can be done.
When finishing is in order, the dam is turned down and the work com-
fortably proceeded with.— Otto E. Inglis, Philadelphia, Pa., The Denial
Cosmos,
Digitized by V:iOOQIC
SELLING DENTURE SERVICE 303
SELLING DENTURE SERVICE
I. J. Dresch, Toledo, Ohio
Although artificial dentures were the first mechanical restorations
made by dentists, denture work is to-day the most poorly paid branch
of dentistry. Notwithstanding the great advancement of the work
it is not as remunerative to-day as it was fifty years ago. To a majority
of dentists with a practice of ^{3,000 or more, denture work is actually
unprofitable. These statements may seem far fetched, even a trifle
pessimistic, but they are hard, cold facts, which must be squarely faced
and eliminated before denture fees can be placed on a proper basis.
In comparison with denture work, a fair fee is received for crown
and bridge work, fillings, inlays, etc. Is there any legitimate reason
why the other forms of work should be more profitable than denture
work? Most assuredly there is not. Then why do such conditions
exist? Let us take an example. Suppose you have a case for a cast gold
inlay; you are extremely careful to apply the most thorough and scientific
knowledge in the cavity preparation, and in securing normal occlusion.
When you have set the inlay you are paid for the material used, general
expense, and your time plus — ^your knowledge. You have been paid
for your professional knowledge. Now on the other hand suppose a
full upper denture is to be made. Perhaps an ordinary plaster impr&sion
is taken with the mouth open, then the patient is instructed to close
the jaws on a roll of wax for the bite. That is as far as the patient's
knowledge of the work goes and to the patient the service is as mechanical
as the Bertillon system of recording thumb prints; and the patient pays
for the service as such. To place denture work on a financial parity with
other branches of dentistry it is necessary for the dentist to be paid for
material, general expense and time plus knowledge. In other words
denture work must be placed on a professional basis before the dentist
can expect professional fees.
Here is how three dentists of a city in the middle West placed their
fees for denture work on a professional basis. In the same city there
are more than one hundred dentists. The average fee for a denture is
$12 and for an upper and lower $20. Twenty of the most progressive
dentists were asked if they endeavored to sell anatomical articulation
to the patient? If they had become acquainted with the closed mouth
method of impression taking and if they explained the beauty of Truby te
teeth to the patient? The astounding result was that seventeen out
of the twenty answered all three questions in the negative. When
asked why they made no effort to sell such service the answers were varied.
Digitized by
Google
304 THB DENTAL DIGEST
One said, ''What is the use? It goes over the patient's head" another
"I do not have time." But all agreed that as a general rule they never
thought of trying to sell anything better. The three dentists who
answered the questions in the affirmative said they always explained the
merits of articulation, scientific impressions and Trubyte teeth. That
they had no trouble in persuading eighty per cent, of the patients
to accept the better service. One said he did not think it would be fair
to the patient to go ahead with the ordinary work and not explain the
better things. These three dentists average $50 for an upper and lower.
They said they often received $60 but the fee would be somewhat re-
duced for some of their old patients, and those not financially able to
pay well.
One was asked how he presented his selling talk to the patient.
His answer ought to mean increased fees for many dentists. "First of
all I explain the difference between an impression taken with the mouth
open, and one that is taken with the mouth closed. The average patient
is interested in how the work will be done so I take time to make aU
perfectly clear to the patient. Then I show the difference between oc-
clusion and articulation. Two specimen cases are best for that; one set
arranged the old way and mounted on a plain line articulator, the other
set anatomically articulated and mounted on a Gysi Simplex. These
specimens make it easy for the patient to understand what articulation
means. Of course I show the beauty and efficiency of Trubyte teeth,
the moulds and shadings as compared with other teeth, and there are
very few patients who do not readily see their superiority."
This dentist has been in the same location seventeen years. His
office is in the residential district of a middle class of people. He has
increased his denture fees one hundred per cent, in the last five years,
and he is not what could be called a good salesman; just a good con-
scientious dentist who has been rendering service. He has found that
people in moderate circumstances will i>ay for service; and he has placed
his dentiu-e work on a professional basis and is being paid professional
fees. He is being paid for material^ general expense and time, plus —
put the plus — ^in your denture fee.
360 Spitzer Bldg.
Bad teeth and ill-kept gums not only look bad, and feel uncomfort-
able if not painful, but they let in more serious disease like rheumatism,
chronic sepsis, and tuberculosis. It doesn't pay to "let the teeth go."
—The Healthy Home.
Digitized by V:iOOQIC
THE SUCCESSFXTL PRACTICE OF DENTISTRY 30S
THE SUCCESSFUL PRACTICE OF DENTISTRY*
By Wallace Seccombe, D.D.S., Professor Preventive Dentistry
AND Dental Economics, Royal College of Dental
Surgeons, Toronto
This excellent article is worthy of careful reading by every dentist who
desires to combine good professional and good business methods. —
Editor.
There was never a time when more exacting demands were made
upon the dental surgeon than the present. Changes in the science and
practice of dentistry are so rapid that a practitioner may become old-
fashioned in j&ve years. Fifteen years ago the younger members of
the profession were universally considered more modern in their prac-
tice than were the older graduates. That time has passed. Advances
have been so rapid that it is not now a question of being old or young,
but whether you are abreast of the times. The advantage has gradually
passed from the younger graduate to the older man, who is familiar
with the best thought of the profession and is able to bring his wider
experience to bear upon modem methods of practice.
The standard of dental service is being continually raised. The
dental graduate who leaves college to-day with the impression that
he can settle down comfortably to the practice of dentistry, dispose
of his college texts, ignore dental magazines and dental meetings, stamps
himself, at the very outset, as a complete failure. Likewise, the older
practitioner who has failed to study the later dental works and has thought
himself too busy to attend dental conventions is also a failure. He
does not render that high quality of service which his years of experi-
ence would otherwise make possible.
Heretofore, there have been those who have argued that the prac-
tice of dentistry would never assume the importance of that of medi-
cine, because in the one case a tooth was at stake and in the other a
life. The logic of that argument has been destroyed through the dis-
coveries of science, that the presence of rheumatism, neuritis, endo-
carditis, gastric ulcer, nephritis, and other systemic lesions are due, in
many cases, to local foci of infection about the roots of teeth. Rose-
now has established conclusively the facts concerning the transmuta-
tion of streptococci, the organism having, in one instance, an affinity
for the joints; in another, for the appendix, or in still another for the
stomach.
•Read before London Dental Society, 24th February, 191 6.
Read before Toronto Dental Society, 13th March, 19 16.
Read before Hamilton Dental Society, 15th March, 10 16.
Digitized by V:iOOQIC
306 THB DBRTAL DIGEST
For many years the dental profession has recognized the relation-
ship between septic conditions in the oral cavity and many systemic
diseases, but that knowledge has been based largely upon clinical experi-
ence. Through the observations of Hunter and Osier, and the ex-
periments of Rosenow, Billings, Gilmer and others, the direct rela-
tionship between local foci of infection in the oral cavity and systemic
conditions of disease has been scientifically shown. The result is that
leading members of the medical profession have come to regard den-
tistry as a most important factor in preventive medicine.
Now what does all this mean? It means that the practice of den-
tistry is a matter not of saving the teeth alone, but of preserving life
and health. It means that much of the present practice of dentistry
will be revolutionized. As a profession we shall have to adopt an en-
tirely different attitude toward the question of the vitality of the teeth
and the treatment of those roots that are comfortable and apparently
healthy, and yet are maintaining a source of systemic infection. It
means that the public will appreciate the importance of aseptic root
canal work, and will, because of the vital issues at stake, demand that
dental service be rendered in conformity with the most advanced me-
thods of practice, and be more willing to pay adequately for that service.
Now let us turn for a moment and ask ourselves the question: What
is the successful practice of dentistry? The successful practice of
dentistry might be defined thus, the rendering of the best possible
service, under the most agreeable conditions, and the acquirement of
fair remuneration for the service so rendered.
When we speak of "rendering the best possible service" we are
dealing with a variable factor. The service rendered by one dentist
may be a very diflferent service to that rendered by another, though
in each case the service may have been *' the best possible." It is like-
wise true that circumstances may compel, in dififerent patients, diflFerent
treatment of similar conditions, and though the operator be the same,
and though he may render the best possible service under the circum-
stances, the service rendered in each case may vary.
Rendering service is, after all, the most important factor in suc-
cessful practice. Unfortunately, skill and success are by no means
synonymous, though a distinct relationship exists between them. Bet-
ter dentistry makes for success, and success encourages better dentistry.
There are many dentists, skilled in the science of dentistry, who
fail entirely in the successful conduct of a dental practice. Upon the
other hand there are those possessing only average skiU, who apply
correct principles in the management and control of practice, and who,
therefore, meet with a fair measure of success. Every member oi the
Digitized by V:iOOQIC
THE SUCCESSFXTL PRACTICE OF DENTISTRY 307
profession should 
Live Music Archive
Librivox Free Audio
Metropolitan Museum
Cleveland Museum of Art
Internet Arcade
Console Living Room
Open Library
American Libraries
TV News
Understanding 9/11